History & Intake Form

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Thank you for completing the History and Intake form. Please note that you can save your progress at any time by selecting Save and Continue Later.
Your WOOFS! Trainer*
- Joelle Cuprak
- Carrie Williams
- Jennifer Thomas
- Eryn Rolison
- Erica Pytlovany
- Laura Sharkey
- Sarah Hampel
- Other / Not Sure
About You
Owner's Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
About Your Dog
Dog's Name*
Dog's sex
- Male – Intact
- Male – Neutered
- Female – Intact
- Female – Spayed
Dog's breed or breed type
Dog's date of birth (approximation okay)
MM slash DD slash YYYY
Dog's current age
Dog's age at spay / neuter, if applicable
How long have you had your dog?
Name of your dog's veterinary clinic
Others in the Household
Please list the NAME, AGE, and RELATIONSHIP of all humans in the household
Please list the NAME, AGE, SEX and SPECIES or BREED of all other animals in the household

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Client Goals
What is the main reason you sought out training?
Has there been any recent change or incident that encouraged you to seek training right now?
Please list your dog’s top 3 unwanted behaviors and describe what occurs immediately before your dog engages in each unwanted behavior.
#1 – Behavior
#1 – What happens right before the unwanted behavior?
#1 – Is the behavior getting better or worse?
- Better
- Worse
- About the same
#2 – Behavior
#2 – What happens right before the unwanted behavior?
#2 – Is the behavior getting better or worse?
- Better
- Worse
- About the same
#3 – Behavior
#3 – What happens right before the unwanted behavior?
#3 – Is the behavior getting better or worse?
- Better
- Worse
- About the same
Has a bite or any other incident been reported to Animal Control?*
- Yes
- No
Please describe the involvement of Animal Control*
What would you like to be able to do with your dog?

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Health & History
Where did you get your dog?
What do you know about your dog's history before they came to live with you?
Does your dog have any illness, injury, or other known medical conditions?
- Yes
- No
Please describe medical conditions
Is your dog currently taking any regular medications?
- Yes
- No
Please list your dog's current medications
Does your dog have any allergies or food restrictions?
- Yes
- No
Please list allergies or food restrictions

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Bite History – Humans
Has your dog EVER growled at, snapped at, or bitten a person?*
- Yes
- No
- Don’t Know
Did any of the bites break the skin or cause injury?*
- Yes
- No
Have any bites required medical attention?*
- Yes
- No
Please provide details about all bites*
Bite History – Dogs and other animals
Has your dog EVER injured, fought, or shown aggressive behavior toward other dogs?*
- Yes
- No
Did any of the bites break the skin or cause injury?*
- Yes
- No
- Don’t Know
Have any bites required medical attention?*
- Yes
- No
- Don’t Know
Please provide details about all bites or other incidents*
Has your dog injured, killed, or otherwise shown aggressive or predatory behavior toward other species of animal?*
- Yes
- No
- Don’t Know
Please describe any aggressive or predatory behavior toward other animals*

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Home & Routines
What type of home do you live in?
- Single family
- Duplex
- Townhome
- Apartment with balcony
- Apartment with no balcony
Do you have a yard?
- Yes – Fully fenced
- Yes – No fence or incompletely fenced
- Yes – Electronic boundary system
- No
Have there been recent changes in the household? (new home, new pet, marriage, children, etc)
What brand and type of food do you feed your dog?
Is your dog fed on schedule or free-fed?
Where does your dog sleep?
What does your dog do, or where is he kept, when you are not home?
Have you ever used a crate to confine your dog?
- Yes – Use crate regularly or occasionally
- Yes – Used crate in the past
- No – Have not tried to use crate
- No – Dog does not like the crate
- No – We do not like the idea of a crate
Describe your dog's daily routine
What does your dog do for physical exercise, and how often?
What does your dog do for mental exercise, and how often?

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Training History
Has YOUR DOG had previous training, either with you or in an earlier home?
- Yes
- No
Please list any classes, private training or other activities that YOUR DOG has participated in.
Please list any trainers, training centers, or other organizations that have been involved in YOUR DOG's training
Did you feel that the training had the desired result?
What is YOUR previous experience with classes or training with a previous dog or other animal.
What trainers, training centers, or other organizations have been involved in YOUR training?
Can you describe the basic approach you use to teach your dog?
Please check any training equipment you are currently using OR have used with your dog in the past
- Clicker
- Head halter (Gentle Leader, Halti)
- No-pull harness (EZ Walk, Freedom harness)
- Standard harness with clip on the back
- Flexi leash / retractable leash
- Choke chain / slip collar
- Prong / pinch collar
- Electronic collar
- Citronella spray collar
- Squirt bottle
- Shake can
- Electronic fence – outdoors
- Electronic fence – indoors
- Muzzle
- Other
If other, please list
What equipment are you currently using to walk your dog?
What are your dog's favorite foods or treats?
What are your dog's favorite toys? How does your dog prefer to play with those toys?
What are your dog's favorite activities?
Phone
This field is for validation purposes and should be left unchanged.

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About You