Detailed Behavior History | Aunt Penny's Professional Dog Training

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Today's Date*
Date Format: MM slash DD slash YYYY
Name*
First Last
Dog Name*
All information provided is strictly confidential. Please complete this form by typing in the blanks provided and return it no later than two days before your PET’S appointment. To properly prepare for your pet’s challenges the specific information requested in this form is needed by the trainer. We do understand that you may have recently acquired this pet or not know the answer to a question – complete it to the best of your ability given the knowledge you have. If there is a problem finishing the form as provided contact us ASAP at info@myauntpenny.com
The person filling out this dogs’ information MUST be a legal owner of the dog.
Please check the box indicating*
- I give consent that a deposit of $50 is non-refundable if you cancel with less than 48 hours of notice from your appt time. Your deposit does go towards your fee for the consult/training.
Please confirm you agree to the following:*
- I agree to pay balance (via PayPal) 24 hours before consult.
- I agree to pay balance pay by CASH ONLY - NO CHECKS on day of appointment.

The legal owner/owners of the dog are:*

List all owners full names

Is ANYONE in the home afraid of this dog ? If so WHY?*
Who is filling out this information
Owners Name*
First Last
Physical Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Work Phone
Mobile Phone*
Email*
Your Occupation*
Do you live in a...*
- House
- Mobile Home/Trailer
- Apartment
- Townhouse/Condo
Has your household changed since acquiring your pet?*
Please select all that apply
- Death of a pet
- Death of a family member
- Illness
- Divorce
- Marriage
- New baby
- College-bound child
- Schedule change
- Pet added
- Other
- No changes

List all family members and NON family members that live in your house:*

To add additional members click on the + sign

Name	Male/Female	Age

Victim	Age	Male/Female	Part of body bit	Medical treatment needed?	Stitches?	Why do you think it happened?

Dog Victim	Size/Age	Male/Female	Part of body bit	Medical treatment needed?	Stitches?	Why do you think it happened?

Who is filling out this information

Name	Species	Age	Male/Female	Get along with dog	When did you get?