Step 1 of 6 16% 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 YouOwner's Name* First Last Phone*Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country About Your DogDog'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 HouseholdPlease list the NAME, AGE, and RELATIONSHIP of all humans in the householdPlease list the NAME, AGE, SEX and SPECIES or BREED of all other animals in the household Client GoalsWhat 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? Health & HistoryWhere 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 conditionsIs your dog currently taking any regular medications? Yes No Please list your dog's current medicationsDoes your dog have any allergies or food restrictions? Yes No Please list allergies or food restrictions Bite History - HumansHas 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 animalsHas 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* Home & RoutinesWhat 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 routineWhat does your dog do for physical exercise, and how often?What does your dog do for mental exercise, and how often? Training HistoryHas 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 trainingDid 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?CommentsThis field is for validation purposes and should be left unchanged.
