Client Intake

New Client Questionnaire

This form is designed to get important information from clients in advance of our first session. The more complete your answers, the better we will be able to help you.

Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Directions and Parking Instructions (if necessary)
Phone Number (Primary)*
Please enter the phone number you would like us to use first when we need to reach you.
Phone Number (Secondary)
f you have a second phone number you'd like us to use for you, please enter it here.
Email Address (Primary)*
Email Address (Secondary)

If you have a second e-mail address you'd like us to use for you, please enter it here.
How did you find us?*
- Google or Other Search Engine
- NextDoor/Neighborhood Billboard
- Referred by Neighbor/Friend/Family Member
- Referred by Veterinarian
- CCPDT (Certification Council for Professional Dog Trainer)
- IAABC (International Association of Animal Behavior Consultants)
- APDT (Association of Professional Dog Trainers)
- Positively.com/Victoria Stilwell Dog Training Academy
- ClickerTraining.com/Karen Pryor Academy
- TAGteach International
- Fear Free Pets
- Other
Note that you can check multiple boxes if you heard about us from multiple sources.
Details of how you found us

If you found us through your veterinarian or a neighbor/friend/family member, please type that person's name in the text box above this message.
How did you find us?
Persons in Household*
Please list the names and ages of everyone who lives in your household or interacts with your pet(s) regularly.
What type of pet do you have?*
- Dog
- Cat
- Rabbit
- Parrot
- Horse
- Other
- Add Another Pet
Please give information about the pet you want trained. If you have more than one pet that needs training, please click "Add Another Pet."
Other
Pet's Name*
Pet's Gender*
- Male
- Female
- Other
Other
Is your pet spayed/neutered?*
- Yes
- No
How old is your pet/When was your pet born?*
How long have you had this pet?*
Pet's Weight*
Pet's Breed*
How did you choose this pet?*
Please tell us a little about why you chose this pet, or how your pet wound up in your household.
Where did you get this pet?*
Please tell us where you got your pet (e.g., breeder, rescue, etc.).
Has your pet had any other owners you know of?*
When was the last time your pet saw a veterinarian?*
Is your pet being treated for any medical conditions? If yes, what are they?*
What type of pet do you have?*
- Dog
- Cat
- Rabbit
- Parrot
- Horse
- Other
- Add Another Pet
Please give information about the pet you want trained. If you have more than one pet that needs training, please click "Add Another Pet."
Other
Pet's Name*
Pet's Gender*
- Male
- Female
- Other
Other*
Is your pet spayed/neutered?*
- Yes
- No
How old is your pet/When was your pet born?*
How long have you had this pet?*
Pet's Weight*
Pet's Breed*
How did you choose this pet?*
Please tell us a little about why you chose this pet, or how your pet wound up in your household.
Where did you get this pet?*
Please tell us where you got your pet (e.g., breeder, rescue, etc.).
Has your pet had any other owners you know of?*
Is your pet being treated for any medical conditions? If yes, what are they?*
Please provide separate information for each pet if you have multiple pets.
When was the last time your pet saw a veterinarian?*
Please describe any other pets in your household*
What kind of food do you feed your pet(s)?*
If you have more than one pet, please provide detailed information for each pet.
Do you give your pet treats?*
- Yes
- No
What kind of treats do you give your pet(s)?*
If you have more than one pet, please provide detailed information for each pet.
Do any of your pets have allergies?*
- Yes
- No
Please describe the allergies.
If more than one pet has allergies, please provide separate information for each pet.
How often do you leave your pet(s) alone, and at what times?*
If you have more than one pet and some of them spend more time alone than others, please provide detailed information for each pet.
Does your pet bark or do anything destructive when left alone?*
If you have more than one pet, please provide detailed information for each pet.
How much time does your family spend playing with and/or training your pet daily?*
If you have more than one pet, please provide detailed information for each pet.
What exercise does your pet get (e.g., walks, playing fetch, etc.)?*
If you have more than one pet, please provide detailed information for each pet.
Where does your pet sleep?*
If you have more than one pet, please provide detailed information for each pet.
Has your pet attended any training classes? If so, what techniques were used?*
If you have more than one pet, please provide detailed information for each pet.
Please give us the names of all the trainers you have worked with in the past, if applicable
Include trainers you worked with in a group setting as well as for private training.
What cues does your pet know (e.g., sit, down, etc.)?*
If you have more than one pet, please provide detailed information for each pet.
How does your pet behave when seeing an unknown person on a walk?*
If you have more than one pet, please provide detailed information for each pet.
How does your pet behave when seeing another animal (e.g., dog, squirrel) on a walk?*
If you have more than one pet, please provide detailed information for each pet.
Are you having behavior problems with your pet? If yes, what are they (e.g., excessive barking, housetraining issues, aggressive behavior towards other animals, etc.)? Please describe the problems in as much detail as possible, including when the problem(s) started.*
If you have more than one pet, please provide detailed information for each pet.
Has your pet ever bitten anyone (human or animal)? If yes, please give the number of bites and describe the circumstances of each bite.*
If you have more than one pet, please provide detailed information for each pet.
Have you and your family tried to solve your pet's behavior problems? If yes, how? What has worked? What hasn't?*
If you have more than one pet, please provide detailed information for each pet.

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