EmailMe Form - Private Training Questionnaire

Owner's Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Main Phone *

### - ### - ####

Secondary Phone

### - ### - ####

Email *

Has your entire family received the COVID Vaccination?

No

Yes

Some members

If Some Members have only received COVID vaccine, explain who has and has not:

Referred to training by

Veterinarian's Name/Clinic *

Vet's Phone *

### - ### - ####

Dog's Information

Please provide as much information as possible.

Dog's Name *

Breed(s) *

Age *

Date Acquired Dog

MM / DD / YYYY

Age at Acuisition

Sex *

Male

Female

Fixed? *

Yes

No

Additional Information

This section helps us understand the best way to train your dog. Please fill out as much as possible.

Vaccinations Current? *

Yes

No

List the health history of your dog *

ex: health issue 1, health isue 2,...

Is your dog on any medication? *

Yes

No

If Yes, what medication and why?

Where did you get your dog? *

Type of Collar and Leash used

Dog's diet *

Dog's daily routine *

Other training *

Show signs of aggression? *

Yes

No

If Yes, Describe

Show signs of fears? *

Yes

No

If Yes, describe

Has your dog ever bitten: *

Where is your dog kept when you are home? *

Where is your dog kept when you are away? *

Where is your dog kept at night? *

In house loose

In house crated

In separate area of house via gate or door

Outdoor dog kennel

Outdoor containment:

Check all items that your dog reacts unfavorably to *

What things upset your dog? *

How is your dog while in the car? *

How does your dog react to being left alone? *

What type of exercise does your dog get? *

How would you describe your dogs personality? *

What bad habits does your dog have? *

What commands does your dog respond to? *

Who does your dog play with the MOST? *

Adults

Children

Other animals

Him/herself

What does your dog prefer to do when you are at home? *

Follow people around and nicely interact

Follow people around and obnoxiously interact

Be in the same area, but not much interaction

Independent and not follow people around

Interact with other pets

What games does your dog like to play? *

How often does your dog come when called? *

90% or more

75%

50%

25% or less

How much improvement would you like to see in your dog? *

90% or more

75%

50%

25% or less

List future goals for you and your dog *

ex: goal 1, goal 2,...

I agree to the terms, conditions and class policies of Canine Tutor, LLC dba Canine University of Ohio *

I agree

I agree to Covid-19 Liabity Release Waiver of Canine Tutor, LLC *

I agree

Date *

MM / DD / YYYY