Coaching/Behavior Consult Form

Name *

Husband/Wife/Partner/ *

Address Including City & Zip *

Is Your Residence A: *

Please select at least one option.

Single Family Home

Condo/Townhome

Apartment

Phone number *

Email address *

How did you hear about us? *

Dogs Name *

Dog's Age? *

Dog's Breed or Mix *

Dog's Sex *

Please select at least one option.

Male

Female

Spayed/Neutered *

Please select at least one option.

Yes

No

Where Did You Get Your Dog? *

If adopted from a shelter/rescue, do we know any of the dogs prior history *

How long was dog in shelter/rescue? *

How old was dog when you got him/her? *

How long has dog been in current home? *

Are there children in the home? *

Who will be involved with the dogs training? *

Are there other pets in the home? If yes, please describe *

What are your dog's training/behavior challenges? *

Please select at least one option.

Reactivity To Dogs & People

House Training

Jumping

Leash Pulling

Socialization Issues

Fear

Other

Please describe any prior training that your dog has had? *

How often do you train your dog? *

What are your training goals? *

What type of walking/training tools are currently being used? *

Who Is Your Current Veterinarian? *

Are there any current medical or physical conditions that might be affecting your dog's behavior? *

Is your dog current on rabies vaccination? *

Please select at least one option.

Yes

No

Has your dog ever bitten/injured a person or animal? If yes, please describe. *

Is your dog currently on HW and Fles/Tick Preventative and what? *

What food are you currently feeding? *

Are your dogs confined to a crate at all during the day? If yes, for how long? *

Additional questions or comments *

What days & times are best for you for training? *

Please select at least one option.

Tuesday

Wednesday

Thursday

Friday

Saturday

Mornings

Afternoons

Please add a photo of your dog(s) *

Positive Touch Dog Training