Intake Form Basic — Shame Free / Force Free

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Basic Intake

Please fill this form out at least 24 hours prior to your initial consultation to avoid having to reschedule. I need time to review the form and evaluate your needs.

Name *

First Name

Last Name

Email *

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Humans in the Household *

Please list all ages

Other Pets in the Home *

Dog Info

Dog's Name *

Age *

Breed *

Gender *

Origin *

Breeder, Shelter, Friend/Family, Stray

Length of Ownership *

Describe the dog's daily routine including daily exercise and enrichment *

Where is the dog kept when no one is home? *

Bite History *

Please be sure to include the details of bite incident(s), along with the date(s) of the incident(s) If this does not apply to you please respond N/A

Vet Info

Vet *

Vet Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Vaccine History *

Rabies

DA2PP

Leptospirosis

Lyme Disease

Canine Influenza

Bordetella

Rabies *

MM

DD

YYYY

DA2PP *

MM

DD

YYYY

Leptospirosis

MM

DD

YYYY

Lyme Disease

MM

DD

YYYY

Canine Influenza

MM

DD

YYYY

Bordetella

MM

DD

YYYY

Existing Medical Conditions *

If none, reply N/A

Training History

House Trained *

Yes

No

Kennel Trained *

Yes

No

Previous Training *

Respond N/A if the dog has no former training or the training history is unknown

What problems are you experiencing? *

What are your goals for training? *

Thanks so much! While you wait for your consultation, you will get a link to a google drive folder that will be your hub for all things training. You will find several sheets and documents that will be used for tracking progress, homework, and any enrichment and management plans we put together.

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