Training ApplicationCLIENT INFORMATION FORMPlease answer the following questions as thoroughly as possible. Subject * Owner's Name * Owner Full Name First Name Last Name Email * Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country How did you hear of us? Which training program are you interested in? Dog's Information Breed/Mix Dog's age Male or Female Male Female Is your dog fixed? Intact Spayed Neutered If spayed/neutered, at what age? If no, do you plan to? Where did you get your dog? Breeder Shelter Rescue Pet Store Friend/relative Found stray Other How old was the dog when you got him/her? Why did you get your dog? Check all that apply: Companionship For the kids For protection To breed Received as gift Sports/work Assistance/service dog/therapy dog/emotional support Companion for other dog Other Have you owned dogs in the past or is this your first dog? Medical Information Veterinarian City Current known health problems/medication Does your dog have any allergies, including food allergies? Is your dog easily handled by the vet staff? Yes/No/Please elaborate Has he/she ever had to be muzzled? Yes No Does your dog let you groom him/her, touch nails, or do ear cleanings? Behavior Compliance For each behavior, state if the dog knows the behavior and how well he/she will comply when asked to perform it. (e.g. yes but only for a second, or "yes 50% of the time") Check all behaviors that apply to your dog: Aggressive (describe below) Fearful (describe below) Anxious when alone Destructive when alone Jumps on people Jumps on furniture Pulls on leash Chews furniture/property Excessive barking Urinates when excited/scared Runs out doors/gates Escapes from yard Excessively seeks attention Understands but will not obey Mouthing/nipping Urinates in house Steals food, trash, and other objects Guards food, toys, bones, etc. Play biting Description Has your dog ever bitten a human or animal? Did the bite break skin? Please explain the circumstances. * My Dog knows ... Sit Strongly Disagree Disagree Neutral Agree Strongly Agree Lay down Strongly Disagree Disagree Neutral Agree Strongly Agree Stay Strongly Disagree Disagree Neutral Agree Strongly Agree Come Strongly Disagree Disagree Neutral Agree Strongly Agree Walk Nicely on a Leash Strongly Disagree Disagree Neutral Agree Strongly Agree Place Strongly Disagree Disagree Neutral Agree Strongly Agree No Strongly Disagree Disagree Neutral Agree Strongly Agree Quiet Strongly Disagree Disagree Neutral Agree Strongly Agree No Strongly Disagree Disagree Neutral Agree Strongly Agree Off Strongly Disagree Disagree Neutral Agree Strongly Agree What are your dogs most undesirable behaviors? When did you first notice the behaviors? Does this problem occur frequently, occasionally, or rarely? Frequently Occasionally Rarely Unpredictably Have there been any recent changes in frequency/severity of this behavior? Describe what you have already done to try and correct your dog's behavior: What are your top 3 main goals for your dog? How much do you feed and how often? Is your dog free-fed (bowl left out all day) or does he/she eat all the food at each feeding? Has your dog ever become possessive of his food or treat? Yes No If yes, please describe in detail: Is your dog food motivated? Is your dog reliably housetrained? Yes Mostly No Is your dog crate trained (this means calm & quiet in the crate)? If no, please explain why. Does your dog have accidents in the crate? Yes No Has your dog ever broken out of a crate? Has your dog ever been boarded overnight before? Yes No Are you willing to begin crating your dog prior to them beginning their training here with us? If no, please explain why * Will you be comfortable following our recommendation of crating/kenneling your dog, at night & when you're not home when they return home from training? Yes No Exercise: How long does exercise last/how often is it provided? If walks are provided, what type of collar & leash do you use? Describe what walking your dog is currently like? How does your dog react to other people, dogs, strollers, bikes, skateboard, etc.? Household information What type of home do you live in? Single family home Apartment Condo Duplex What is your yard set up like? Do you have a fence, invisible fence, do they go out on leash? Has your dog ever jumped a fence? Yes No List all the people, including yourself whom live in your household Does your dog like children? Yes No Are any household members afraid of or dislike the dog? Why? Is the dog afraid of any household members? Why? Where is the dog kept while you are away? Where does the dog sleep at night? Does your dog growl when anyone tries to move him/her off furniture? If so, please explain How does your dog react to being left alone? Is there any separation anxiety? Distructive behavior? How does your dog behave when someone enters the house? Fearful, aggressive, over excited? How does your dog behave in the car? Do you have any other pets? Yes No If so, what kind, breed, age? Has your dog shown any aggression towards any of the other animals in the home? How does your dog get along with other animals outside of the home? Training History Does your dog have prey drive? (react to birds, squirrels, cats, etc?) No prior training Trained him ourselves Group class Private lessons Board and train How long ago was the training completed Which training tools (harness, food, prong collar, e-collar, gentle leader) did the trainer use? Were they effective? Why do you think you and your dog would be a good fit for A Balanced Dog's training program? * I am familiar with A Balanced Dog's training method, techniques and programs. * Are you familiar with A Balanced Dog's training methods, techniques, and programs? Do you understand that depending on what we are working on and have discussed, we may suggest the purchase of tools such as prong collar, e-collar, place cot, etc. If not, refer to our many videos of our work on our Facebook and YouTube page. Yes No Are all members of the household on board with training? If no, please explain. * Have you read over our website program descriptions and FAQs page? * Yes No Thank you!
