Name
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First Name
Last Name
Co-owner Name (if applicable)
First Name
Last Name
Phone
*
(###)
###
####
Email Address
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Children and Ages (if any)
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How and where did you hear of us?
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Have you moved with your dog within the last 12 months?
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Yes
No
Have you added or lost any pets within the last 12 months?
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Yes
No
Have you added or lost any family members within the last 12 months?
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Yes
No
What do you want to accomplish with this consultation?
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Dog's Name
*
First Name
Last Name
Dog's Age
*
Breed or Mix
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Is your dog up to date on their rabies vaccination?
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Yes
No
What is your dog's sex?
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Male
Female
Is your dog fixed?
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Yes
No
At what age was your dog fixed?
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Did your dog’s behavior change in anyway after being altered?
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Yes
No
What changed?
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Has your dog ever had a litter of puppies?
Where did you get your dog?
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How long have you had the dog?
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Other Pets In The Home
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Include name, age, breed, male/female, and fixed or not
Vet Clinic
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Vet's Name
*
Vet's Phone
*
(###)
###
####
Vet's Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
List all medications and supplements your dog is currently taking
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Please list any current or past medical issues including surgeries, infections, etc.
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Dog’s allergies?
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Where is your dog when he is home alone?
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Where does your dog sleep at night?
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Does your dog have a crate?
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Yes
No
If yes, please describe whether your dog likes the crate, chews/destroys the crate, where it is located, and how many hours your dog spends alone in it each day.
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What kind/brand of food do you feed your dog?
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How much and how often does your dog eat?
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Is food left out during the day for your dog to eat?
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How does your dog respond to grooming or bathing?
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What kind of toys does your dog have daily access to?
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How long does your dog play with toys?
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Where are the toys kept when not in use?
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Has your dog ever been quarantined or involved with animal control for any reason?
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What kind of environment was your dog raised in before 8 weeks old?
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How much interaction has the dog had with dogs and people during the first year of their life?
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If you got your dog as a puppy, what kinds of places did you take him to before he was 4 months old?
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If you got your dog as a puppy, what was his reaction to dogs when he was under 4 months old?
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Does your dog listen to you inside your home?
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Yes
No
Does your dog listen to you in your yard?
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Yes
No
What is your reaction when your dog ignores you?
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What pet stores, doggy day cares, vet clinics, groomers, or other pet facilities did you take your dog to before the age of 6 months old?
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Please list any of the following tools that you currently use or have previously used with your dog: Martingale Collar, Prong Collar, Choke Chain, E-Collar, Bark Collar, Citronella Collar/Spray, Spray Water Bottle, Clicker, Extendible Leash, Waist Leash, Front-Attach Harness, No-Pull Harness, Regular Harness, Head Halti, Gentle Leader, or Others.
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How old was your dog when you began noticing your dog’s reactions?
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What behaviors does your dog know without hesitation while at home? (e.g. sit, stay, lay down, etc.)
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Which of these does he/she without hesitation outside the home?
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Is your dog destructive or a nuisance to neighbors in any way while you’re away?
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Does he react and/or bark at dogs while looking out the windows?
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What do you do to reward your dog for good behavior?
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What do you do to discourage undesirable behavior?
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List rewards your dog absolutely loves (include food, treats, toys with specific brands, types, etc.)
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Do you take your dog to dog parks?
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Yes
No
How often does your dog go on a walk?
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Who walks your dog?
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How long is the walk?
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Does your dog have any other exercise activities?
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Does your dog pull on the leash?
Yes
No
What tools have you used to try to curb pulling?
Do you ever walk your dog off leash?
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Yes
No
What is your response when you see another dog or person coming down the street?
What is your dog’s response when he spots another dog or person 100+ yards away?
What is your dog’s response when he spots another dog or person 50-100 yards away?
What is your dog’s response when he spots another dog or person 20-50 yards away?
What is your dog’s response when he spots another dog less than 20 yards away?
Distance that your dog does not react?
Types of dogs that bother him most? (Size? Breed? Color? Age?)
Has he ever met another dog on leash? If so, what happened?
Has he ever met another dog off leash? If so, what happened?
What is the dog’s reaction to visitors in your home?
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Describe your dog’s reaction to children visiting.
Describe your dog’s reaction to adult women visiting.
Describe your dog’s reaction to adult men visiting.
Does your dog react to accessories such as canes, large coats, or hats? If so, what accessories?
What is the dog’s reaction to adults while out and about on a leash?
Your dog’s reaction to children while out and about on a leash?
What is the dog’s reaction to people or children while off leash in an enclosed area outside of the home/yard?
Has your dog had any negative experiences with people in the past? If so, please describe:
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Does your dog have any odd or unusual behaviors inside the home?
Does your dog have any odd or unusual behaviors in your yard?
Does your dog have any odd or unusual behaviors outside your home or yard?
Other quirks your dog has:
What type of learner are you?
*
Visual Learner
Kinesthetic Learner
Audible Learner
How much time can you dedicate to training each week?
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Coaching requires the owner to practice each exercise for at least 10-15 minutes, three times a day.
Who do you think the training is for?
*
The dog, human or both?
What is the best way that I can help you?
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Explain what you expect from your trainer. (Examples include follow-up notes, the timing of responses to questions, etc.)
5 Things You Like About Your Dog
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5 Things You Wish You Could Change About Your Dog
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What made you reach out to us for training assistance?
*
What would you like to accomplish through training?
*
How would your ideal dog behave like?
*
How long are you expecting training to take to reach your goals?
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What is the biggest obstacle keeping you from reaching your goals?
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Agreement of Release & Waiver of Liability
*
By checking "I agree" below, I hereby have reviewed and agree to the following:
1. I represent and warrant that my dog(s) is physically fit and has no medical conditions that would prevent their full participation in any training class. I agree to have my dog(s) clean and free of fleas and parasites before the first training along with proof that my dog(s) are up to date on all vaccinations. These vaccinations are to remain current throughout the duration of trainings.
2. In consideration of my dog(s) being permitted to participate in training, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, to third parties, which might incur as a result of my dog(s) participating in training.
3. In further consideration of my dog(s) being permitted to participate in training, I knowingly, voluntarily and expressly waive any claim I may have against Meghan Prague for injury or damages, which my dog(s) or I may sustain as a result of participating in training classes.
4. I hereby waive and release Meghan Prague of any and all liability of any nature or damage which I or my dog(s) may suffer, including specifically, but not without limitation, any injury or damage resulting from action of any dog(s), and assume risk of any such damage or injury while attending any training session held by Meghan Prague.
5. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue Meghan Prague for any injury or death caused by her negligence or other acts during the training of my dog(s) or while on your premises or any surrounding area thereto.
6. If Dog(s) causes property damage, or bites or injures any dog(s), animal(s) or person(s) who is a third party to this Agreement, during or after the term of this Agreement, then Client agrees to pay all resulting losses and damages suffered or incurred to the third party.
7. Meghan Prague reserves the right to refuse service to anyone. You can make your payment to Meghan Prague by check (or pay in cash) by the first day of training. Children under the age of 18 years must be accompanied by an adult. Junior handlers must be at least 10 years old.
8. We allow two rescheduled appointments. All packages must be completed within a 7-week time frame. All sessions completed after 7 weeks of the start of training will be charged an extra $90 per session.
9. The class payment is non-refundable and upon a returned check from the bank for any reason I agree to pay a $25.00 returned check fee.
10. Any photographs taken by Meghan Prague of you and/or your dog(s) during training is the property of Meghan Prague and can be used on her web-site, advertising or marketing publications.
I agree