Dog Consult Questionnaire Pet Owner Information Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * How did you hear about Shake It Off Dog Training? * Please list the other HUMANS with whom you share your home. For children, include their NAME(S) and AGE(S). Pet Information Dog's Name * My dog is: * Male Female Dog's Age * How old was your dog when they first came to live with you? * Dog's Breed Dog's Weight * Where did you get your dog? Please indicate the particular shelter/rescue, breeder, or if through a friend, as a stray, or from and online ad). * Please list the other PETS who occupy your home, including their SEX, SPECIES and AGE. Veterinary Information What veterinarian/veterinary clinic do you use? * Veterinarian's Phone Number * (###) ### #### When was your dog's most recent vet visit? Is your dog fully vaccinated and up to date on vaccines (including Rabies vaccine) ? Is your dog spayed/neutered? * Yes No If yes, at what age was your dog spayed/neutered? Does your dog have a current, or previously relevant, medical condition? Is your dog currently taking any medication? If yes, please explain. * Pet History Describe your dog's daily routine * What does your dog do for exercise? How often and for how long? * What are your dog's favorite activities? What kind of toys/chews does your dog enjoy? Does your dog like to deconstruct stuffed toys? * What do you feed your dog for meals and when do you feed? Include brand of food, if it is kibble, freeze dried, raw, canned etc. Is your dog allergic to any foods? * What are your dog's favorite foods or treats? * Does your dog have dog friends outside of your home that he/she enjoys playing with? Training Information Have you done any previous training with your dog (yourself, private lessons/group classes with a professional)? Describe the basic approach that was used (positive reinforcement, rewards based, balanced, assertive/dominance, corrections/aversives). Did you feel you got the results you were looking for? * Please list your dog's current skills. * (e.g. sit, lay down, recall, walking on leash, stay, shake, bow, go to mat, crate trained, wait at door, drop it, leave it, hand target) In the order of importance, please list the goals and/or behavioral issues for which you seek assistance. * If you are experiencing RESOURCE GUARDING, AGGRESSION, or REACTIVITY with your dog, please respond to the below questions. Otherwise you may skip to the last question. When did the behavior first happen? Please describe bite incident(s), if any. Include the date, location, and whether there were injuries. What is your vision for life with your dog? Is there anything else you'd like to share? * Thank you!
