Private Consultation Form

First Name(required)           Last Name (required)

Home Phone (required)         Cell Phone              Work Phone

Email (required)             Secondary Email

How would you prefer to be contacted? EmailPhone

Home Address:
Street(required)                City(required)

State(required)      Zip Code(required)

Mailing Address (if different)

Household members (human) - Names and Ages

Other pets living in household: (Species, Names, Ages)

Dog’s Name:  Breed/Mix:
Weight:    Dog's Date of Birth:

MaleFemaleSpayed/NeuteredIntact

If Spayed/Neutered; At What Age?

How old was your dog when you got him/her?

Where did you get your dog?

What Brand/Type of Food do you feed your dog?

How many times a day do you feed your dog?

How much do you feed your dog per meal?

Veterinarian:

List any medications your dog is currently taking:

Does your dog have any current medical issues?

Please describe any previous medical conditions

Type of Class/Course you are looking for:(check all that apply)
Puppy MannersAdult MannersBeyond MannersParent EducationPrivate Consultations

What is the reason for your contacting Animal Manners?

When did these issues begin?(Please be as specific as possible):

How often do the problems occur?(Please be as specific as possible):

What vocabulary words does your dog currently understand? (example: Sit, lie-down, stay, etc.):

Training attempts to resolve the problem(s)? If yes, please describe in detail when, where, with whom and what you learned. Type of discipline, management, training, etc.:

What was the dog’s response to the above training attempts? (check all that apply)
BetterWorseRemained the same

Previous Training:(check all that apply)
No training yetTrained him ourselvesPuppy GroupBasic GroupIntermediate GroupAdvanced GroupPrivate LessonsSent to trainer

Please describe the training methods used: (check all that apply)

Please describe the training tools used: (check all that apply)
Flat CollarBody HarnessNo-pull HarnessHead HalterMartingaleChoke/Slip CollarProng/Pinch CollarE-CollarCrateTetherBaby gatesX-Penlong-linesInvisible Fencing

How much, and what type, of exercise does your dog get per day?

Does your dog attend Doggie daycare or have a dog walker? If yes, how many days/hrs. per week?

How many hours is your dog left alone per day? Is your dog free in the house, crated, other?

How would you describe your Dog Experience level? Please Explain:
First Time OwnerSomewhat ExperiencedExperienced

What are your Goals for this dog?

Is there any other information you would like to share about your dog?

Where did you hear about Animal Manners?

What is your preferred day and time for our training sessions?
Monday, Tuesday, Wednesday, Thursday:

Hours: 9:00am to 7:00pm:

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