The information below will help us better assess you and your dog's needs. Thank you.
Handler's Name Home Phone Cell Phone Email
Address City State Zip
Dog's Name Dog's Age Dog's Sex
Breed of Dog Vet's Name Vet's Phone
With strangers is your dog ---Select One---FriendlyReservedFearfulAgressive Is your dog: (Check all that apply) Protective of familyProtective of propertyOveractiveStartled by loud noise (away from home)Startled by sudden movements (away from home)Sluggish
Has your dog: Ever bitten anyone? ---Select One---YesNo Nipped children in play? ---Select One---YesNo Wet when excited? ---Select One---YesNo Wet when punished? ---Select One---YesNo
What distracts your dog the most? Other dogsFoodKids/PeopleOther What games does your dog like? BallTug-of-warOther
Is your dog: (Check all that apply) Kept in a fenced yardOn a chainUse a crateIn the country, no fenceAllowed in the houseDoes he jump fences Does your dog: Use a dog houseHave toysGo for walksDig to get under fencesRide with youStay in a dog run (or like)Have tick and flea protection
What? When?
How many? Adults Children Ages? Other dogs Other pets What do you feed the dog? When do you feed the dog? Bed Time Wake Time Do you: Physically correct him? ---Select One---YesNo Verbally correct him? ---Select One---YesNo
Has there been any changes in your routine? New job with different hoursA child starting schoolA child leaving homeA death in the familyA death of a petVisiting relativesMarriageDivorceA new babyNew petsWent to see his/her parents
Where did you get him/her: From a homeFrom a breederFrom the Animal Shelter What age?
Has he/she ever been: MistreatedBoarded outStolenObedience TrainedHousebroken
Has your dog ever Had major illness Had major injury Date of last vaccination Date of Rabies shots Date of Bordetella Been wormed by the Vet When?
Had or Sired puppies Been spayed/neutered Had a false pregnancy Refused to eat
Is your dog: OverweightUnderweightOn medication
List Medications
Does your dog: Vomit sometimes? ---Select One---YesNo Cough much? ---Select One---YesNo Sneeze much? ---Select One---YesNo Have gas much? ---Select One---YesNo Scratch much? ---Select One---YesNo Chew on his feet? ---Select One---YesNo Have regular seasons? ---Select One---YesNo
Please check bad habits you would like to resolve Jumping on peopleChewing things in yard or houseDigging holes in yardRuns in or out of house, car, gate, or doorsEats cat’s foodRowdy or wrestling in houseGets on furnitureBegging when anyone is eatingExcessive barkingCrosses boundaries in house or yardJumps fencesNips, licks, sniffs, or paws peopleMisbehaves in carChases children at playNot housebrokenTakes food from tableChases the cat
List any other behavior modifications desired
Please check good behavior or commands you would like your dog to learn Sit, stayTravel well in carStand for groomingBark when someone comes to your houseDown stayHeel nicely at your sideCome when calledWait at doorwaysSleep out at nightGo to his place in house, stay there until you say “OK”Sleep in at night
By continuing, you agree to the following:
Thank you for choosing GUARANTEED DOG TRAINING to care for your dog. We will do our best to make his (her) stay a safe and happy one. If your dog stays with us for two or more weeks, you may attend any of the classes given by GUARANTEED DOG TRAINING free of charge.
In order for us to care for your dog we must be assured that his shots are current and his health is good. Your signature below will assure us of this and will also release GUARANTEED DOG TRAINING of responsibility for any unforeseen event involving your dog.
I understand that it takes at least 12 weeks of conditioning a dog in controlled situations in order to keep his new good behavior patterns. Therefore, I agree to follow the instructions given me at my handling lesson when my dog is returned to me.
Check this box if you agree to the above terms