Note: ALL FIELDS ARE REQUIRED FOR SUBMISSION
How did you hear about us?
---Google searchWebsiteFlyer/AdFacebook/social mediaRuff House client referralVet referralOther
If you were referred by a Vet, vet office or Ruff House client please tell us their name we can thank them!
What Services Are You Interested In?
Group ClassesEvaluationPrivate/Session TrainingBoard & Train
Emergency Contact Information (if you're unavailable):
Emergency Contact Name (Authorized to pick up dog)
Emergency Contact Phone
Sex of dog
Age of dog
Weight of dog
Breed of dog
Color of dog
Vaccination Due Dates
Where did you get your dog?
How long have you had your dog?
Has your dog ever been around other dogs?
What is your dog's personality?
Happy Go LuckyAffectionate/SweetDefiant/SnottyHostile/ViciousLaid Back/LazyHyper-active
Feeding & Medication:
What brand of food do you feed your dog?
Are you willing to change brands of food?
Amount of food given per meal
Name(s) of any medication
Amount of medication(s) given
Frequency of medicaiton(s) given
Special medicating instructions
List any/all of your dog's chronic health issues, allergies or medical concerns
Brand of flea & tick treatment
Date last given flea & tick treatment
Brand of heartworm preventative
Date given heartworm preventative
Name of vet clinic
Vet clinic phone
Dog's Current Exercise Regiment:
What type of leash and collar do you use for walks?
On walks, does your dog....
Tell Us About Your Home:
How many other people live in your home?
How many of those people are children?
What are the ages of the children?
Are there other animals in your home?
Dog(s)/Cat(s), Breed(s) & Age(s)
Do you have a fenced in yard?
Where does your dog sleep?
Is dog allowed to freely roam the entire house?
Is dog completely house-trained?
Is dog crate trained?
What is your dog's attitude towards the crate?
Have you boarded your dog before & how often?
Has your dog been to doggie daycare before & how often?
Where does dog poop/pee?
If dog poops/pees in backyard, is it on or off leash?
How often does dog poop?
Does dog potty on command, what command?
Does your dog only potty during walks?
If dog poops/pees only on walks, is it on or off leash?
Has you dog attempted to jump/climb/dig under/escape from yard?
Does your dog have any fears?
List any specific circumstances that incite fear in them
Does your dog have separation anxiety?
If so, please describe
Does your dog excitement/nervous/submissive pee?
When did this start?
With other dogs?
With small animals?
While playing with a toy?
While chewing a bone?
List any special circumstances
What commands does your dog respond to?
What results or experiences good or bad, do you have from past formal training?
Is your dog food motivated?
Is your toy motivated?
What equipment do you use during training eg: harness, prong collar, gentle leader, or other?
Additional Important Information:
Has your dog ever nipped, bitten or scratched at a dog or person and drawn blood?
If so, please explain the circumstances
What is the main issue/concern with your dog you would like to address?
Secondary/additional issues/concerns you'd like addressed?
Incident and/or example of the issue(s)
Has your dog ever been medicated for this issue or any others?
If so, please explain the issue or behavior for which they were medicated
What are your specific expectations for training?
What are your Top-3 goals for training?
Is there anything else you would like us to know?
© 2018 - Ruff House Dog Training & Behavior Modification - 8830 North La Canada Drive, Tucson, AZ 85704