Detailed Behavior History - Aunt Penny's Professional Dog Training

Canine Questionnaire

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

"*" indicates required fields

Step 1 of 11 - Basic Information

Today's Date*

Penny is a Nationally Certified Professional Dog Trainer CPDT-KA * Certified FEAR FREE Professional Licensed Family Paws Educator for the International Dogs & Storks ® and Dogs & Toddlers ™ programs.

Your Name*

First Last

The legal owner/owners of the dog are:*

List all owners full names

Address of owner*

Cell Phone*

Home phone

Email*

We will send correspondence to this email.

Would you be available sessions on:*

Weekend sessions can take a month to get.

Is there a certain day of the week that works best for you?*

My daytime hours are 11-4 pm evening is 6-9. Weekends are 1-7 pm.

Would you consider your need for a trainer urgent (within 3 days)?*

There is a $100 urgent fee. I will change my schedule for urgent cases. Most sessions take 2 -4 weeks to schedule. There is no guarantee of availability but every effort will be made to respond quickly.

Are you expecting a baby? If yes, when?*

Are you adopting a baby? If yes, when?*

Do you have a baby or toddler currently in your home?*

Do you have children under the age of 10 in your home on a regular basis?*

Has your dog bit or threatened a child?*

Has your dog ever been deemed a dangerous dog by the courts or by animal control?*

Has your dog ever killed any animal? If so what animal?*

List all ( including you) family members and NON family members that live in your house:*

To add members, click the plus sign.

Name

Male/Female

Age

Is anyone in your home afraid of this dog?*

Please explain.

List all pets that live in your house:*

To add pets, click the plus sign.

Name

Species

Age

M/F

Get along with dog?

Date gotten

Upload a photo of your dog.

If your image is online, use the other field to add the link instead.

Accepted file types: png, jpg, Max. file size: 256 MB.

Add link to photo instead of upload

Files should be JPG, PNG or WEBP

Did you acquire your dog after 3 months of age?*

Did you acquire your dog at 6 weeks of age or less?*

Was your dog acquired from a shelter or a pound?*

Has your dog had multiple owners during his/her life?*

Was your dog acquired from a pet shop?*

Has your dog had multiple owners during his/her life?*

Was your puppy an orphan or hand raised?*

Was your dog the single puppy in a litter?*

Dog's Name*

Dog's breed*

Color

Age*

Sex*

Is your dog sprayed/neutered?*

Age of neutering?

Is your dog microchipped*

Is your dog CURRENT on their dog license?*

Name of current veterinarian*

Name of vet clinic*

Vet Address*

Street Address City State ZIP Code

Vet Phone Number*

Consent*

I give permission for Penny Layne to contact my vet/vets or their staff - for any reason for health, safety, to collect more info, or to discuss my dog/ dogs before or after my consult/training.

We must have consent to accept a new client.

Is your dog able to be handled by the vet without a muzzle?*

Yes

Date of last physical*

Flea/Tick prevention name?*

If none – mark N/A

Heart worm prevention name?*

If none – mark N/A

Are all vaccines current?*

Yes

Any dog 12 weeks and older must have rabies as this is a state law

Does your dog have any medical issues?*

Yes

Please explain the medical issues.

Has your dog been seen for these medical issues?*

Yes

Pease list all current medications & supplements:

Please include the dose

NAME of dog food*

Frequency of feeding*

Other food/treats/table scraps:

Does your dog eat:*

Do you have to be present to eat?*

What exercise does your dog get and how often?*

Does your dog go to the dog park*

Does your dog go to doggie daycare?*

Do you have a fenced-in yard or the Invisible Fence?*

What height is your fence? ( if not invisible)

What are your goals for training?*

What 3 things do you love the most about your dog?*

What 3 things don’t you like about your dog?*

The following questions DO NOT mean we are recommending this.

Are you considering rehoming your dog?**

Are you considering euthanizing your dog?*

Is there anything else you would like to tell us about your dog and its behavior?

Please initial here acknowledging I have been honest with the trainer for both her safety and the success of my dogs’ consult/ training.*

Thank you for taking the time to complete this form. Your answers will allow us to serve you better. We look forward to meeting with you and your dog. If you have any questions, please do not hesitate to ask.

By electronically signing below, you agree to the foregoing terms of payment:

Signature*