New Client Intake Form

Name(Required)

First Last

Email(Required)

Phone number(Required)

2nd Owner's Name (First and Last)(Required)

2nd Email

Phone

Address(Required)

Street Address Address Line 2 City State ZIP Code

What Neighborhood Are You In?

Are there children in your home?(Required)

Yes

Other

Please list names and ages.(Required)

Dog's Name? *(Required)

What is your dog's breed?(Required)

What is your dog's age? (if under 24 weeks old, please specify in weeks) *(Required)

Dog's Birthday?(Required)

What gender is your dog? *(Required)

Male

Female

Is your dog neutered or spayed? *(Required)

Yes

Date of neuter/spay?

Does your dog have any food allergies?

Are there additional pets in your home? Please tell us about them.(Required)

Who is your Veterinarian? *(Required)

What services are you interested in? *(Required)

Daycare (Beginning in Early April)

Virtual Private Training

In-Home Private Training

Puppy Socialization Class (8-18 wks)

Adolescent Socialization Class (18 wks-10 mo)

Basic Obedience Class

Tricks Class

Baby-on-the-Way

Pre-Puppy Preparation

Behavior Modification (Aggression/Sep Anx)

ESA/Therapy Dog Preparation

Travel Preparation (Crate/Bag Training)

What specific issues are you experiencing with your dog? *(Required)

Housetraining/Accidents

Puppy Separation Anxiety (under 6 mo)

Puppy Nipping/Chewing (under 6 mo)

Jumping on People

Jumping on Furniture

Excessive Barking (Protest/Demand/Referee)

Adult Dog Separation Anxiety (over 6 mo)

Puppy Separation Anxiety/Protest Barking

Dog on Dog Aggression OFF Leash (Biting/Fighting)

Dog on Dog Aggression ON Leash (Biting/Fighting)

Leash Frustration (Lunging/Growling/Barking)

General Anxiety

Fear of Strangers

Fear of Other Dogs

Fear of Inanimate Objects

Leash Walking- Pulling/Dragging/Lunging

Sound Sensitivity/Fear of Noises

Biting Another Dog 1-5x (NOT puppy play)

Biting Another Dog 6-10x (NOT puppy play)

Biting Another Dog 11x or More (NOT puppy play)

Biting A Human 1-5x (NOT puppy nipping)

Biting A Human 6-10x (NOT puppy nipping)

Biting A Human 11x or More (NOT puppy nipping)

Resource Guarding (Food/Toys/Humans)

Territorial Aggression (Home/Bldg/Dog Park)

Aggression Towards Children/Babies

Aggression Towards Inanimate Objects

Other:

Please Describe

Is there any additional information about your dog or situation you feel would be helpful for us to know?(Required)

Have you done any previous training (puppy classes, basic obedience, private sessions) with your dog?(Required)

Yes

How did you hear about us?(Required)

Vet Referral

Daycare

Social Media

Friend/Family Member

Trained with us previously with a different dog

Other:

Please Describe

Preferred trainer to work with?(Required)

Kate Perry

Sherri Bohlig

No Preference

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KPDT New Client Intake Form

“Creating the best possible relationship between you and your dog.”