Client Intake Form

Name: ___________________________ Date: _____________Address: ___________________________ Dog’s Name: _____________

___________________________ Breed: _____________Phone: ___________________________ Age/Sex: _____________E-mail: ___________________________ Spay/Neut.? _____________Ref. by: ___________________________

Other Pets in Household: ___________________________________________Other People in Household: __________________________________________ Occupation/Time spent outside home: ___________________________________

Veterinarian: ______________________________________________________Medical Problems/meds/allergies: _______________________________________

Brand of Food: ________________________ how many times per day? _______ what times is dog fed? _____________ eat right away/finish meals? __________Other treats/snacks & how often: _______________________________________

Where was dog obtained/How long ago: _________________________________Housebroken? _____ Crate trained? _____ Where does dog sleep? ____________% time indoor/outdoor? ________ Where kept when owner gone? ____________

Any previous training? Behaviors dog knows/training methods used/trainer: ____________________________________________________________________________________________________________________________________Exercise Type/Frequency: ____________________________________________Equipment used on walks: ____________________________________________Has dog ever bitten or injured a person or animal? ____ (If yes, describe in Notes section

Reason for Consultation: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Notes: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________