Client Questionnaire Order Number Date * Consultant Name * Email Address * Phone Number * Cell Phone Street Address * City/State * Zip Dog's Information Dog's Name * Dog's Age Dog's Sex Breed Type * Dog License # and County How long have you had the dog? Dog's age when acquired? Where did you get the dog? Spayed/Neutered? If so, at what age? Number of people in the household? How many children and ages? Other dogs in the home? Other pets in the home? Your experience level First time owner Somewhat experienced Experienced Veterinarian List any medications your dog is taking Training Experience Has your dog had any training? Yes No How long ago? Check one or more: Self/Home Group classes (where) Private trainer (name) Board and Train (where) What type of training? Please describe the methods & equipment used to train your dog. What commands does your dog know how to do? Behaviors Please describe any behavior issues your dog may have: When were the problems first noted? How often do the problems occur? What has been done so far to correct the problems? Type of discipline, confinement, training, etc. What was the dog’s response to these corrective measures? Lifestyle & Habits Where does your dog sleep? How often do you feed your dog? Once Daily Twice Daily Free Feeding What type of food? Please list brand and recipe How often and what type of daily exercise does your dog get? Does the dog have any physical problems or limitations? How long is your dog left alone? Does your dog have any issues with being left alone? Please describe. What makes your dog bark, lunge, or growl? Is your dog overprotective of any of the following? Food Toys Property You or another person Has your dog ever attacked another dog? Please describe the circumstances and outcome Has your dog ever killed another animal? Please describe the circumstances Has your dog ever been attacked? Property, You or another person Please describe: When, where, who, why, how Please list Three (or more) activities that your dog likes/loves: Please list Three (or more) foods that your dog likes/loves: What are your goals for this dog? My Dog Is: Calm and Quiet Yes No Submissive Yes No Independent Yes No Jumps up on people Yes No Pushy and Rough Yes No Wary/Shy of Strangers Yes No Attentive Yes No Other Yes No Easily Distracted Yes No Housebroken Yes No Easy to Groom Yes No Eager to Please Yes No Confident Yes No Easy to Handle Yes No
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