Emma Kesler, CDBC, CPDT-KA Client Form
Thank you for your interest! This form is to be considered for dog behavior consulting / coaching with Emma Kesler, CDBC, CPDT-KA.

BEFORE YOU APPLY, please review the following:

1) If approved, it can take 4+ weeks to get into the schedule.

2) Be aware for the Coached Sessions portion of our program, we will need to meet weekly on the same day/time. These meetings are not scheduled on weekends. If you are traveling, meeting in different locations isn't a problem with wifi and/or cellphone data.

3) These programs are not compatible with invisible fences.
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Email *
Today's Date *
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Your Full Name *
Cell Phone Number *
Address: Street *
Address: City *
Address: State / Province *
Address: ZIP / Postal Code *
Address: Country *
What time zone are you in? (Example: CST, PST) *
Family Members *
Please describe each family member's relation and children's ages
If you live with a partner or spouse, provide their full name, email address (please do not put your own email address!) *
Current other pets
Please list and describe your other current pets. Age, species, breed. Please be detailed in your answer.
Do you use an iPad or iPhone? *
(It is ok if you do not)
Dog's Name *
Dog's Breed *
Dog's Date of Birth *
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DD
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Dog's Current Age *
How old was your dog when you got him/her? Provide any other details you are aware of about your dog's life prior to coming home with you. If you haven't gotten your dog yet, please just provide any relevant information about when you might be bringing the dog home, how old they will be, etc. *
Please specify where your dog came from, or will come from (rescue/shelter, private party, breeder) and provide details. *
Did you grow up with dogs? If yes, tell me about them. Breed, temperament, etc. *
Have you owned dogs as an adult? If yes, please tell me about them. Breed, temperament, etc. *
Please check all that apply (SKIP if you don't have the puppy or dog yet): *
Required
Has your puppy or dog ever snapped at someone, or bitten? Please be detailed. No judgement! *
Is your dog spayed/neutered? If so, at what age was your dog spayed/neutered? *
What type of food does your dog eat (Or what are you planning on feeding your new dog?) *
Do you have a yard? *
Please note: It is perfectly ok if you don't have a yard!
How often is or will your puppy/dog be left alone at home? PLEASE read through the following options and be as accurate as possible. *
IMPORTANT: When are you NOT available over the next 3 months? Please provide day/time ranges that do NOT work for you, and dates of any trips planned. Please be detailed! *
How did you hear about this service? *
Please describe any previous training history and/or methods: *
How motivated are you to learn a new way of training? *
Not Very Motivated
Very motivated
Which service/program(s) are you inquiring about? *
Required
Please summarize your concerns and/or goals, any previous training or history of note, and explain why you feel you would be a good candidate to work with Emma Kesler, CDBC, CDPT-KA. Spots are limited, please be detailed: *
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