Name
*
First Name
Last Name
Pronouns
Phone
(###)
###
####
Email
Address (for invoicing purposes)
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Availability for training sessions (indicate which days of the week and times you are most available for scheduling).
What kind of Consultation are you considering?
How did you find out about Head and Heart Training?
*
I prefer for the trainer to wear a mask while working indoors
Dog(s) Names
Dog(s) Ages
Dog(s) Sex (are they Spayed/Neutered)
List all members of your household (name, age, pronouns)
Dog's origin (adopted, from breeder)
How long have you had your dog for?
Other household pets
When is the last time your dog had a vet checkup?
List any medical Issues your dog has, or has had historically
Please any medications or supplements that your dog is on.
Please list any food allergies or sensitivities.
Have there been any recent changes to your dog’s health?
What issues are you looking for help with?
When is the last time you had a new person in the home, and how did your dog respond?
How does your dog respond to being left alone?
Please describe briefly each time your dog ever growled at, lunged at, bitten, or acted aggressively to any person or animal this has happened, and how long ago the incident took place.
Please describe the extent of the injuries to people or animals that have been bittenby your dog (bruising, shallow vs deep punctures, multiple bite marks or just onebite, has your dog ever killed another animal?)
Do your dog’s aggressive behaviours occur during touch, petting, or body handling?
Do you feel like there has been a recent and sudden change in your dog’s temperament or personality?
