Questions Form

Client's name* Dog's Name: Address: Phone Number: May I Text Your Phone? Yes No How Did You Hear About Canine Solutions Dallas? Where Did you get your Dog? Dogs Age: Male or Female?* Intact Male Intact Female Altered Male Altered Female Dogs Breed: What are your top 3 behavioral concerns for your dog? What Training are you interested in? Board & Train Group Training Service/ESA Dog Training Private training (upon approval) How does your dog respond to strangers when they enter your home? (Check all that apply) Ignores Excitedly greets them in a friendly manner Jumps on people Growls/barks while retreating Growls/barks while going toward them My dog would bite people if I did not restrain them Other How does your dog respond to strangers when he/she meets them away from home? (Check all that apply) Ignores Greets them excitedly in a friendly way Jumps on them Growls/barks while backing away Growls/barks while going toward them My dog would bite someone if I did not restrain him/her Other Please check all that your dog needs help with. (Check all that apply) Housebreaking Jumping on People Digging and Chewing Play biting/mouthing Pulling on the leash Reating poorly to other dogs while on leash Bolting out of doorways Running away Stealing things Chasing (kids, cat, cars, etc.) Mounting People Mounting other dogs Excitability in the car Excessive barking Fearfulness & Shyness Over protective Marks Territory Seperation Anxiety Begging Crate Training Whining Growling Biting/Nipping Possessiveness (Resource Guarding-wont allow you to take items away or won't allow other dogs around their items Food Aggression Doesn't listen Over Active Eats Feces Counter Surfing What type of exercise does your dog get? Is your dog on any medications? Yes No If so, for what and how long? Is your dog prone to recovering from any injuries? How do you feed your dog? Free Feed (food is always available) Specific times Where does your dog sleep? (Check all that apply) In a crate In a family members bed In his/her dog bed Outside of house Other Please list all animals/pets in your home and ages.* Please give us your work schedule that we will schedule your appointment around. We are in certain areas on specific days of the week. Knowing your work schedule allows us to work in those parameters. Do You feel a phone call prior to your appointment is necessary? If so please know times are very limited for phone calls and you could be charged a fee for a phone consultation depending on the duration of the call. Yes No Maybe Yes, I have reviewed the training options and disclaimers on Canine Solutions Dallas' website. Yes No