Owner Name* First Last Profession*Co-owner/ Partner Name* First Last Co-owner's/ Partners ProfessionPrimary 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*Puppy's Name*Breed (or mix)*Current Age*What age when obtained?*Sex*MaleFemaleSpayed/Neutered?*YesNoIf yes when?*If puppy is too young for spay/neuter at this time when do you plan to have it done?*if you do not plan to spay/neuter can you expalin why?*Heartworm medication (brand)*Flea/tick medication (brand)*Has your puppy ever had ticks or have you found a tick on your puppy? 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 puppy?Where/who did you get this puppy from?What challenges do you face with your new puppy?Where does your puppy sleep at night?*Where does your puppy hang out when you are not at home?*How much time does he spend alone during the day?*Is your puppy crate trained?*YesNoWork in progressAny problems crate training?*YesNoHow does puppy feel about the crate?*LoveTolerateDislikeDestructiveEscapes or triesWhere is the crate located in your home?*What specific brand/ type of food do you feed this puppy?*UntIs 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)?*ScheduleFree-fedWhere is the puppy food kept in the house?*Does your puppy dislike/ act afraid or timid toward people or dogs? If yes who? how? when? explain.*Does your puppy have any fears or sensitivies if so to what or whom?*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*Does your puppy nip/bite/chew on you and/or family members? Does your puppy chew/steal objects that it should not have? Describe each of the above behaviors & your reaction to them.*Does your puppy guard food, water, toys, the couch, bed or any other objects? if so Who? When? Where? Please describe what your puppy does in this situation with as much detail as possible.*Does your puppy get regular exercise? if yes how often? when? 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 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?*YesNoNameThis field is for validation purposes and should be left unchanged.