Basic Client Information Emergency Information Basic Dog Information Behaviour and Training Training Client Info Emergency Dog Info Behaviour Training Name First Name Last Name Date Date Address Address Postal Code Contact Email Cell Phone Work/Home Phone Emergency Contact First Name Last Name Phone Permissions In the event of an emergency do we have permission to bring your dog to Central Animal Hospital? Yes No Have you filled out and submitted a waiver form? (If not, please make sure you do before the date of your training session) Yes No Name Dog Name Birth Information Age Birthday Sex Female Male Breed Where did you get your dog? Breeder Rescue Shelter Other Please name the breeder/rescue shelter (if applicable) How old was your dog when you got them? Please include any helpful comments or notes. Current Health Weight Are vaccinations up to date? Yes No Is your dog spayed or neutered? Yes No Does your dog have any allergies? What type/brand of food does your dog eat? Does your dog have any medical conditions? History Has your dog had professional training? Yes No What level of training has your dog completed? (If applicable) What company did your dog train with? (If applicable) Behaviours Does your dog come when called? Yes No Sometimes Does your dog tend to chase cats, squirrels, deers, birds, etc.? Yes No Sometimes When give the chance, does your dog bolt out the door or away from you? Yes No Does your dog bark profusely when someone comes to the door? Yes No Sometimes Rarely Does your dog calm down after visitors come in? Yes No Sometimes Is your dog calm at home when you go out? Yes No Sometimes Does your dog snap or growl when being touched or groomed? Yes No Sometimes Rarely Is your dog fearful of people or dogs? People Dogs Both Neither Has your dog ever been attacked? Yes No Unsure (rescue dog) Has your dog ever attacked a dog or person? Yes No Unsure (rescue dog) Does your dog exhibit general aggression on leash? Yes No Sometimes Rarely Does your dog exhibit aggression towards other dogs? Yes - both on and off leash No - neither on or off leash Only when off leash Only when on leash Does your dog exhibit aggression towards people? Yes - both on and off leash No - neither on or off leash Only when off leash Only when on leash Does your dog exhibit aggression when food or toys are involved? People Dogs N/A Is your dog crate trained? Yes No Please include any details or information you think would be helpful. Training Goals What are the issues you would like to address? What are the goals you would like to accomplish through training? Please provide any other information, questions or concerns you have. One last thing... How did you hear about Thumbs Up Dog Training? SHOW SUMMARY Some required Fields are emptyPlease check the highlighted fields. Submit Previous Step Next Step
