Owner Information:

Note: ALL FIELDS ARE REQUIRED FOR SUBMISSION

Name

Address

City

State

Zip

Email address

Cell Phone

Home/Work Phone

Communication Preference

How did you hear about us?

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

Dog Information:

Name

Sex of dog
FemaleMale

Age of dog

Weight of dog

Breed of dog

Color of dog

Vaccination Due Dates

Spayed/Neutered
YesNo

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?

Feeding & Medication:

What brand of food do you feed your dog?

Are you willing to change brands of food?
YesNo

Amount of food given per meal

Feeding frequency

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

Veterinary Information:

Name of vet clinic

Vet's name

Address

City

State

Zip

Vet clinic phone

Dog's Current Exercise Regiment:

Exercise Routine/Schedule

Exercise Duration/Distance

What type of leash and collar do you use for walks?

On walks, does your dog....
PullLungeZig-ZagMarkBarkWhineWalk Ahead

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?

Dog's Behavior/History:

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?
YesNo

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?
Thunder-LightningSirensFireworksLoud TrucksMotorcyclesNone

List any specific circumstances that incite fear in them

Does your dog have separation anxiety?
YesNo

If so, please describe

Does your dog excitement/nervous/submissive pee?
YesNo

When did this start?

Reactive/Negative/Guarding Behaviors:

With humans?
YesNoUnknown

With children?
YesNoUnknown

With cars?
YesNoUnknown

With other dogs?
YesNoUnknown

With cats?
YesNoUnknown

With small animals?
YesNoUnknown

During feeding?
YesNoUnknown

While playing with a toy?
YesNoUnknown

While chewing a bone?
YesNoUnknown

List any special circumstances

Training Information:

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?
YesNo

Is your toy motivated?
YesNo

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?
YesNo

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?
YesNo

If so, please explain the issue or behavior for which they were medicated

Training Expectations/Goals:

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?

Note: ALL FIELDS ARE REQUIRED FOR SUBMISSION