Georgia Dog Trainers Basic Information Form
Please answer the questions that follow as thoroughly as possible. This form should be received with your deposit at least a week before the training appointment. All answers are confidential and will help us to serve you better.
Email address *
What is the owner’s name? *
Your answer
What is today's date?
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What is your address? (with city, state, and zip) *
Your answer
What is your mobile phone number? *
Your answer
Where are you currently living? *
What is your dog's name? *
Your answer
What is your dog's Breed/Mix? *
Your answer
How old is your dog? *
Your answer
How much does your dog weigh?
Your answer
Is your dog:
Is your dog:
If spayed/neutered, at what age?
Your answer
If spayed/neutered due to a behavioral problem, please explain.
Your answer
Select what barriers you have below:
How did you hear about us?
What was the name of the organization or individual who referred you to us?
Your answer
Where did you obtain your dog? *
How long have you had your dog?
Your answer
Were there previous owners?
Your answer
If yes, why was the dog given up?
Your answer
What type of ID does your dog possess?
Why did you get your dog? Please check all that apply.
Have you owned other dogs in the past? If so, what breed?
Your answer
List any physical/breed characteristics that contributed to your choice for your current dog.
Your answer
MEDICAL: What is the dog's veterinarian's name?
Your answer
What city is the veterinarian located in?
Your answer
Month/Year of last visit?
Your answer
Reason for visit?
Your answer
Date last vaccinated?
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What vaccine(s) were given?
Your answer
What are the dog's current health problems/medications?
Your answer
What are the dogs past medical conditions/treatment?
Your answer
Does your dog have any allergies, including food allergies?
Your answer
Does your dog have:
Is your dog easily handled by the vet staff?
Is your dog on heart worm preventative?
Is your dog on flea and/or tick preventative?
Has he/she ever had to be muzzled?
May we contact and discuss health and behavioral issues with your veterinarian?
DIET AND ELIMINATION: What type of food do you feed? (e.g., raw, dry kibble, canned)
Your answer
How often do you feed your dog?
Your answer
How much food do you feed your dog each time?
Your answer
At approximately what time do you feed your dog?
Your answer
Does your dog finish all food at meals?
If not, how long is the food left before eaten?
Your answer
Does your dog receive other treats/chewies?
If so, how often and what kind?
Your answer
Please list 3 of your dog's favorite foods/treats:
Your answer
Has your dog ever become possessive of his food or a treat?
If so, please describe in detail how?
Your answer
Is your dog reliably house trained?
Is your dog crate trained?
Paper/Pad Trained?
Litter Box trained?
Do you have a dog door?
If not, how many times daily do you let your dog out? (or take him on walks)
Your answer
How many times per day does your dog normally defecate?
Your answer
EXERCISE: What type of exercise does your dog get?
Your answer
How long does the exercise last?
Your answer
Who is normally responsible for exercising your dog?
Your answer
If walks are provided, what type of collar and leash is being used? (Collar examples: “regular buckle collar”, “head halter”, “body harness”, “pinch/prong collar”, “choke chain”. Leash examples: “6-foot nylon leash”, “retractable leash”.)
Your answer
Does your dog ever become reactive toward other dogs or people on walks? If so, please describe:
Your answer
ENVIRONMENT/LIFESTYLE: List all people, including yourself, who live in your household: Name Gender Age (of children) Relationship to you
Your answer
Who will be responsible for practicing training exercises with the dog?
Your answer
Does your dog “belong to” a particular household member (e.g., son) or everyone?
Your answer
Do any household members dislike the dog, and if so, why?
Your answer
Are any household members frightened of the dog, and if so, why?
Your answer
Is the dog frightened of any household members, and if so, why?
Your answer
Where is your dog kept when you are not at home? (mark all that apply)
When you are at home, is your dog allowed in the house?
If your dog is not allowed indoors at all, why not?
If your dog is an outdoor dog, would you like him to eventually be able to be indoors?
If indoors, is your dog ever confined (crated, penned) while you are home?
If so, how long is your dog confined on an average day? Why? How is the dog confined?
Your answer
Where does your dog sleep at night?
Your answer
How many hours per day is your pet without human companionship?
Your answer
Do you have other pets? If so, what kind, breed, age, sex, neutered?
Your answer
Three things I like about my dog:
Your answer
Three things I do not like about my dog:
Your answer
If your other pet is a dog or cat, how does your dog get along with the other pet?
Your answer
Does your dog play with toys or play games? If so, what are his favorite toys/games? (These may be interactive games like tug or toys he plays with alone.)
Your answer
What other activities does your dog enjoy?
Your answer
TRAINING: Training methods used (check all that apply):
How has your dog been trained?
Select the behaviors your dog knows.
Select all behaviors that apply to your dog:
List any procedures/training equipment you’ve used to try to correct the behaviors checked above
Your answer
What would you like help with, in order of importance?
Your answer
Has your dog ever bitten anyone?
Has your dog ever bitten any animal?
If so, please describe in as much detail as possible
Your answer
Has medical attention been necessary (for humans or animals) because of any aggressive incident?
If yes, please explain:
Your answer
What is your dog’s usual reaction when a person he has not met before enters the home?
Your answer
When was the last time a person unfamiliar to your dog entered the home?
Your answer
Is there anything else you feel it would be important for us to know?
Your answer
What is your expectation for the success of he behavior modification program?

How much time do you feel you can commit to a behavior modification program?
Are the other members of your household equally dedicated to the work involved in a behavior modification program?
What are your deal breakers? What would cause you to terminate the relationship with your dog?
Thank you for taking the time to complete this form. Your answers will allow us to serve you better. We look forward to meeting with you and your dog.
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