Owner Name* First Last Profession* Co-owner/ Partner Name* First Last Co-owner's/ Partners Profession Primary Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Primary Phone*Cell PhoneWork PhoneEmail* List any chidren (or other occupants) living in the home please list their names and ages*Dog's Name* Breed (or mix)* Current Age* What age when obtained?* Color Sex* Male Female Spayed/Neutered?* Yes No If yes when?* Heartworm medication (brand)* Flea/tick medication (brand)* Has your dog ever had ticks or have you found a tick on your dog? if so when?* Vet Clinic* Vet's Name* Location of Clinic (city)* Vet Phone* Any Medical issues past or present? Please list in detail & include medications perviously or currently taken.Are there any dogs currently living in your home or have lived in the home in the past 18 months? besides the on you listed. Please list name, sex, atered, and breedWhat is the reason for yur contacting us?*What are your intended goals through training/behavior modification?Why did you get this specific dog? Where/who did you get this dog from? What challenges do you face with this dog?Where does your dog sleep at night?* Where does your dog hang out when you are not at home?* How much time does he spend alone during the day?* Is your dog crate trained?* Yes No Any agression in/ around the crate?* Yes No How does your dog feel about the crate?* Love Tolerate Dislike Destructive Escapes or tries Where is the crate located in your home?* What specific brand/ type of food do you feed this dog?* How often do you feed & how much at each meal?* Is your puppy fed on a schedule ( food is not left out/bowl is picked up after meals) or free-feed ( food is left out/ bowl is not picked up)?* Schedule Free-fed Where is the dog food kept in the house?* Where are your dog's toys kept?* How long will your dog play with you- engage with you & not walk away or go of on his own?* Does your dog dislike certain people or dogs? Who? Explain.*Does your dog have any fears or sensitivities? If so to what?*how does your puppy respond to grooming* How do you respond to your puppy when s/he misbehaves/ doesn't listen?* List previous trainers/boarding facilities by name/location*Has your dog ever urinated on you, other family members or non-family members? If so When & Where?*Has your dog ever growled at you, other family members or non-family members? If so who, when & where?*Has your dog ever snapped/bitten at you, other family members or non family members? If so who, when & where?*Does your dog guard food, water, toys, the couch, bed or any other objects?* Yes No Does your dog guard or become protective of you or other family members? If yes please describe what your dog does in this situation with as much detail as possible.*Does your dog get regular exercise? When? How often? How long? What does it consist of?*Do you use any of the following tools or techniques? Check an that you've used in the past or are currenly using* Choke Chain Prong Pinch Collar Electric Collar Alpha Roll Scruff Shake Spray Bottle Buckle Collar Gentle Leader Harness Halti Martingale Slip Lead Limited Slip Collar Felix leash (retractable leash) Leather Leash British Slip Leash Nylon Leash Chain Leash Regarding the above checked items, tell us in what way you felt each techique/tool affected your dog/*Give us any other details or specifics about your dog that you feel we should know. The more info we know the more we can help you and your dog!Regarding the above checked items, tell us in what way you felt each techique/tool affected your puppy.*If you have some aggression issues please tell us about aggressive tendencies, incidents, and details surrounding any of your puppy’s aggressive behavior. Was it directed at a dog (or dogs) and/or person? Where? When? How?*Would You Like To Receive Emails From us in the Future?* Yes No NameThis field is for validation purposes and should be left unchanged.