Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Email Address
*
Other Members of Household:
Please include relationship and age of any children.
How did you hear about me?
*
Note/Message
Dog's Name
*
Sex
*
Weight
*
Color
*
Neutered
*
Other Household Pets
Age, Sex, Spay/Nueter:
Vet Clinic
*
Current Medications:
Dog Allergies
*
If yes, list allergies here
Current or past medical problems or injuries:
Is this dog currently on Heartworm Preventative:
*
Is this dog currently on flea / tick preventative
*
Describe primary feeding routine
How often are you feeding, Do you leave the food out, use an Interactive feeder, make your dog wait, in the crate etc...
What are your training expectations
*
Your immediate and future goals?
What kind of training has your dog had
*
Select all that apply.
If you had training, with who and what did you learn?
Is the dog crate trained?
*
This means OK in the crate with the door closed and no one home.
Describe issues surrounding crate training
Allowed to roam free in house when you are not home?
*
Allowed to run free in yard?
*
Allowed on furniture?
*
How does your dog react when you leave?
*
Have you seen any signs of Separation Anxiety?
Describe walking on a leash:
*
Tell more all bout your walks, good and bad, how long and frequent are they.
Do you let your dog meet other dogs on leash?
*
If yes, how does it go?
What kind of collar or harness are you using or have used in the past?
*
Front/back clip harness, flat collar, martingale, choke, english slip lead, pinch/prong, E-collar
How does your dog react to other animals?
*
Cats, birds, squirrels, etc.
Does your dog play off leash with other dogs?
*
At Day care, a fenced in or off leash hours at parks, "Play Dates" at your or a friends/family home…
If yes, how does your dog do during off leash play and socialization?
How does your dog react when strangers approach your home, yard, or out in public?
Is your dog startled or scared of loud noises?
*
Thunderstorms, fireworks, loud trucks, buses, carts, skateboards etc…
If Yes describe:
Is your dog sensitive to any parts of his/her body being touched?
*
Ears, mouth, paws, nails, backend, etc
If yes, explain:
Is your dog possessive of or ever growled/snapped over food, toys or other objects?
*
If yes, please describe the incident/s
The more information you can give the better.
Has your dog ever growled at someone?
*
Human or Dog, other than over an object discussed above.
If yes, please describe the incident/s
The more information you can give the better.
Has your dog ever bitten someone?
*
If yes, please describe the incident/s
Did the bite break skin? The more information you can give the better.
Does your dog obsessively:
*
If so, explain:
Are there any OTHER behaviors or problems you would like addressed?
Jumping, counter surfing, barking at the doorbell etc..
What are your dog's best qualities and what does your dog love to do the most?
*
Thank you for choosing Canine Cohen, and filling out the training application.
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CanineCohen.com | 646-872-3461
