Name
*
First Name
Last Name
Email
*
Phone
(###)
###
####
Dog's Name
Dog's Age
Spayed/Neutered
Yes
No
How long have you had your dog?
Describe what triggers your dog’s reactivity. (e.g., dogs, people, vehicles, sounds, handling, etc.)
What does your dog’s reactive behavior look like? (e.g., barking, lunging, growling, hiding, etc.)
Has your dog ever bitten another dog?
*
Yes
No
If yes, describe the incident(s):
Has your dog ever bitten a person?
*
Yes
No
If yes, describe the incident(s)
Check any behaviors your dog has shown:
How much time do you have each week to dedicate to training and enrichment?
Who lives in the household with your dog? (Include ages of children and other pets)
Are all household members committed to the behavior plan?
Yes
No
If no, explain:
Are you working with any other trainers, vets, or behavior professionals?
Yes
No
If yes, list them and the methods implemented here:
What are your primary goals for your dog through this program?
What are your expectations for this course and the trainer?
Have you participated in any previous training or behavior programs?
Yes
No
If yes, describe the experience and results:
