Behavioral Problem Solving
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Personalized Training
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Schedule of Classes
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Pet Questionnaire
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send us your concerns.
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Puppy Training
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Please take the time to fill out this questionnaire thoroughly and carefully. The information you provide serves as the essential core of the training goals we design and accomplish.
PERSONAL INFORMATION
First Name:
Last Name:
Address 1:
Address 2:
City:
State:
Select...
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Home Phone:
Day Phone:
Cell Phone:
Email Address:
Best Time To Call:
DOG INFORMATION
Name of Dog:
Breed:
Date Of Birth:
Sex:
Select
Female
Male
Spayed:
Select
Yes
No
QUESIONNAIRE
When the doorbell rings, does your dog bark and/or run to the door?
No / Rarely
Sometimes
Frequently
Does he demand attention by asking to be petted or to play?
No / Rarely
Sometimes
Frequently
Does the dog jump up on visitors (and sometimes you)?
No / Rarely
Sometimes
Frequently
Does your dog ignore you when you call him to come?
No / Rarely
Sometimes
Frequently
Does he exhibit destructive behaviors, i.e., ruining furniture, etc.?
No / Rarely
Sometimes
Frequently
Does your dog attempt to escape from your house or yard?
No / Rarely
Sometimes
Frequently
Does your dog have housebreaking accidents in the home?
No / Rarely
Sometimes
Frequently
Does he chew on items such as shoes, children's toys, trash, etc.?
No / Rarely
Sometimes
Frequently
Does your dog play too roughly with children and/or adults?
No / Rarely
Sometimes
Frequently
Does your dog bark while outside, at passers-by, or just about anything?
No / Rarely
Sometimes
Frequently
When left alone, does your dog show signs of separation anxiety?
No / Rarely
Sometimes
Frequently
Does he dig holes in the yard?
No / Rarely
Sometimes
Frequently
Does your dog show unusual behavior or anxiety at the vet hospital?
No / Rarely
Sometimes
Frequently
Does your dog "steal" items, such as food from counters or tables?
No / Rarely
Sometimes
Frequently
When in a "stay," does he leave the stay before being released?
No / Rarely
Sometimes
Frequently
Does your dog show any aggression toward other dogs or people?
No / Rarely
Sometimes
Frequently
Does your dog run up the stairs and/or through doorways ahead of you?
No / Rarely
Sometimes
Frequently
Does he walk ahead of you or pull you when on the leash?
No / Rarely
Sometimes
Frequently
Does your dog mouth or nip people's hands, arms, or feet?
No / Rarely
Sometimes
Frequently
Has your dog ever bitten a person or another dog?
Yes
No
What behavior or skills you most would like your dog to learn?
(To select more than one choice, press ctrl and mouse click)
housebreaking
sit
stay
down
wait
leave it
All of the above
What is your dog's relationship to other animals
How does the dog behave with unfamiliar visitors?
How is your pet's health?
Name of Vet.
Veterinarian's Phone Number:
Has your dog had previous obedience training?
NA
Yes
No
Started class but did not finish?
NA
Yes
No
Graduated obedience class?
NA
Yes
No
If so, when?
How old was the dog when obedience training began?
Behavioral problems you are experiencing?
(To select more than one choice, press ctrl and mouse click)
Jumps on family members and visitors
Paws at you or others
Mounts people
Barks at you
Barks at other times
Please describe the behavioral problems.
Signature Validation
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