*Required
Full Name *
Home Address *
City *
State *
Zipcode/Postcode *
Email Address
Home Phone Number
Cell Phone Number
Which service or package are you interested in? *
Owner's Occupation *
Children and ages
Other Household Members
Dog's Name *
Breed *
Dog's Gender *
Dog's Age *
How long dog has lived in current home? *
Are there other dogs in home? *
If yes, list names, breeds, ages, and sex
Are there other animals in home? *
If yes, what kind of animals?
Reason why you contacted a trainer *
How did you learn of Paws of Nature Dog Training? *
Name of Veterinarian *
Do we have your permission to discuss your case with him/her? *
Yes No 1. Where did you get your dog? At what age? *
2. If an adoption or rescue dog, do you have any background information on the dog? *
3. If you took classes or had previously worked with a private trainer, where did you take classes or who was your trainer? *
4. When was your dog last vaccinated? *
5. Has your dog been tested for Lyme Disease in the past year? *
6. Date of last vet visit *
7a. Any current medical problems? *
7b. Currently on any medication? *
8. Any past medical problems? *
9. Any injuries in the past that needed urgent medical attention? *
10. What kind of food do you currently feed your dog? *
11. How many times a day do you feed your dog? *
12. Do you have a yard? If yes, is it fenced? *
13. If you use an underground fence system, did you install it yourself? *
13a. If yes, did you train the dog yourself to learn the boundary? If no, who installed the system (company)? Did they train your dog to learn the boundary? How long did it take to train your dog to the boundary?
14. If you don’t have a fence, do you tie your dog out? If yes, please describe. *
15. Describe how your dog acts towards new people coming into your home. *
16. Is there a certain type of stranger that your dog is uncomfortable with? Describe. *
17. How does your dog act around children? Does age of child matter? *
18. Describe how your dog acts passing and/ or meeting strangers out on a walk. *
19. Has your dog ever snapped at or bitten someone? How many people? If yes, please give details of incidents in question 20. *
20. Describe person or persons who were bitten and what they were doing when bitten. Start with the earliest incident, approximate date, to the most recent incident. List all bites including snaps that did not make skin contact as well as bites that did not do any damage. List where on body they were bitten and description of bite wounds.
21. Did anyone seek medical treatment? *
22. Did any incident get reported to your town Animal Control Officer? *
23. Is there any area of your dog’s body that he acts sensitive about being touched by you or anyone else? Describe. *
24. Describe how your dog acts when you or another person approaches or touches him when he’s eating his food. *
25. Describe how your dog acts when you or someone else tries to take... a bone away. *
25a. a favorite toy away *?
26. Do you allow your dog on your furniture? Bed? *
27. Has your dog ever growled, snapped, or bitten at you or someone else while he is lying down on his dog bed or in his crate? If yes, please describe. *
28. How does your dog act while you are getting ready to leave the house? Check all that apply. *
panting excessively trembling whimpering barking following you from room to room eyes wide and dilated jumping on you mouthing you biting you other 29. Is your dog loose or confined while being alone? If confined, where? *
30. How does your dog act while you are gone? Vocalizing? Destruction? House soiling? *
31. How does your dog react when you come home? *
32. Any major change within the household or household routines since acquiring dog? *
33. Is your dog housetrained? If no, on a scale of 0 to 100% reliable in the home, what % would you rank your dog? *
33a. If no, what have you tried in the past to housetrain your dog?
33b. If no, how many accidents in the past week? Locations of accidents?
34. Does your dog do any of the following pushy or attention seeking behaviors? Check all that apply. *
Bark at you Whine Stare Lean on you Paw you Climb on you Jump in your lap Jump at you Lick you Mouth you Push at you with nose Sit on your feet 35. How long will the barking or whining last? *
36. Have you tried to curtail excessive barking? What methods have you tried? *
37. Does your dog chew up things in the house while you are home? How have you dealt with this? *
39. What type of equipment do you use when taking your dog for a walk? Check all that apply. *
Flat buckle collar Prong collar Choke chain collar Gentle Leader head halter Halti head halter Harness Easy Walk front clip harness Sensation front clip harness Martingale limited slip collar 4 foot leash 6 foot leash Retractable leash Other 39a. Describe how your dog acts when he sees the following while out on a walk:
Skateboards: * Bicycles: * Children playing with a soccer ball or basketball: * Motorcycles: * Cars: * 40. Describe what your dog does when he sees other dogs on leash. Check all that apply. *
bark excitedly high pitch barking barks anxiously happy barking barks aggressively growls shows teeth lunges bites at leash tail tucked under tail up high ears flattened ears pricked forward hackles raised tries to hide or move away whines jumping tries to bite other dog Other 41. At what distance from the other dog does your dog first start exhibiting any of the above behaviors? *
42. Does your dog act this way to all breed types and sizes? If no, which breed types or sizes does he get reactive at? *
43. How have you dealt with this in the past? *
44. Has your dog ever met any dogs while on leash? Describe. *
45. Describe how your dog acts when he sees or hears other dogs and/or people while he is inside the house? *
46. How have you dealt with this? *
47. Describe how your dog acts when he sees other dogs and/or people while he is in the confines of his yard. *
48. How have you dealt with this? *
49. Is your dog secured or unsecured while in the car? *
50. Does your dog drool excessively in the car? Vomit? Whine? *
51. Describe how your dog acts when he sees other dogs and/ or people while riding in the car. *
52. Does it matter if the car is moving or stationary? *
53. Does he like riding in the car? *
54. How often is your dog allowed off leash? Where? *
55. Does your dog ever interact with other dogs off leash? Describe his behavior off leash with other dogs. *
56. Any dog fights? If yes, please list in order from the oldest incident to the most recent by approximate date. Describe where the incident took place and who was involved. Describe how each situation was handled and list any bite injuries to your dog *
57. Did your dog or any dog he was involved in a fight need veterinary treatment afterwards? *
58. Is your dog sensitive to sounds? Describe. *
59. How does your dog act at the veterinarian’s office? *
60. Has the vet ever needed to muzzle your dog? *
61. Please list any other behavioral problems that have not already been listed that you need to discuss and give as many details as possible. *
62. Describe how you or others play and interact with your dog. Check all that apply. *
Fetch and retrieve ball Fetch and retrieve Frisbee Fetch and retrieve other object Tug Throw object but doesn’t do full retrieve Throw object and chase dog around Chase dog around Rub belly Wrestle with dog Play fight with dog Pat dog all over like a drum Pet head Hug dog Kiss Dog Let dog kiss you Other 63. How would you best describe your dog’s personality and temperament? *
64. Name 5 things you love about your dog. *
65. If your dog could speak and understand English, and I asked him what are his 5 favorite things to do, how would he answer me? *
