CLIENT INFORMATION FORM – PUPPY PACK ACADEMY
Today’s Date ______ / _______ / ________
Please answer the questions that follow as thoroughly as possible. This form should be received with your deposit
at least a week before the training appointment. All answers are confidential and will help us to serve you better.
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Owner’s Name Dog’s Name
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Address Breed/Mix D.O.B. or Age
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City State Zip Weight Color/unique markings
______________________________________________ O Male O Female O Intact O Neutered O Spayed
Home Phone Work Phone
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Cell Phone Occupation If spayed/neutered, at what age?
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Email If spayed/neutered due to a behavioral problem, explain.
O House O Townhome O Apartment O Other ___________ Fenced yard? O Yes O No Invisible fence? O Yes O No
How did you hear about us?
___ Veterinarian ___ Former client ___ Internet ___ Advertisement ___ Breeder ___ Rescue/Shelter
___ Pet-related business ___ Other: _________________________________________________________
Name of referring individual, organization or publication: _________________________________________
Where did you obtain your dog? O Breeder O Individual O Shelter O Rescue Group O Pet Store
O Friend/Relative O Found stray O Other: _________________________________________________________
How long have you had your dog? _____________________ Were there previous owners? _________ If yes, why was the
dog given up? _______________________________________________________________________________________
Type of ID O Microchip O Rabies/License Tag O Name Tag O Tattoo O Other: __________________________
Why did you get your dog? Please check all that apply:
____ Companionship ____ For the kids ____ For protection ____ To breed ____ Received as gift
____ Sports/Work (e.g., competition obedience, agility, hunting): _________________________________
____ Assistance/Service dog/Therapy dog/Emotional Support dog: ________________________________
____ Companion for other dog ___ Other: ___________________________________________________
Have you owned other dogs in the past? _______ If yes, what breed? _______________________________
List any physical/breed characteristics that contributed to your choice for your current dog:
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MEDICAL:
Veterinarian’s Name _________________________________________ City___________________________________
Month/Year of last visit ______ / _______ Reason ________________________________________________________
_____________________________________Date last vaccinated: _____ / _____ Vaccine(s) given: _________________
Current health problems/Medications ___________________________________________________________________
Past medical conditions/Treatment _____________________________________________________________________
Does your dog have any allergies, including food allergies? _________________________________________________
Is your dog easily handled by the vet staff? O Yes O No Has he/she ever had to be muzzled? O Yes O No
Is your dog on heartworm preventative? O Yes O No Brand ______________________________________
Is your dog on flea and/ or tick preventative? O Yes O No Brand _______________________________________
May we contact and discuss health and behavioral issues with your veterinarian? ___________
If yes, please initial here ________
DIET AND ELIMINATION:
What type of food do you feed? (e.g., raw, dry kibble, canned) _______________________________________________
How often?________________ How much? ______________ At approximately what times? _______________________
Does your dog finish all food at meals? O Yes O No If not, how long is the food left down? ______________________
Does your dog receive other treats/chewies? O Yes O No Frequency/type: ____________________________________
Please list 3 of your dog’s favorite foods/treats: ____________________________________________________________
Has your dog ever become possessive of his food or a treat? O Yes O No Please describe in as much detail as possible:
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Is your dog reliably housetrained? O Yes O Mostly (infrequent accidents) O No
Is your dog crate trained? O Yes O No Paper/pad trained? O Yes O No Litter box trained? O Yes O No
Do you have a dog door? O Yes O No If not, how many times daily do you let your dog out (or take him on walks) to
eliminate when you are at home? _____________ How many times per day does your dog normally defecate? _________
EXERCISE:
What type of exercise does your dog get? (If not receiving any exercise at this time, note “none” and the reason.)
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How long does the exercise last/how often is it provided? (For example, “a 15-minute walk three times daily,” or “plays with
neighbor’s dog for an hour once a week.”) ___________________________________________________________
Who is normally responsible for exercising your dog? ______________________________________________________
If walks are provided, what type of collar and leash is being used? (Collar examples: “regular buckle collar,” “head halter,”
“body harness,” “pinch/prong collar,” “choke chain.” Leash examples: “6-foot nylon leash,” “retractable leash.”)
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Does your dog ever become reactive toward other dogs or people on walks? O Yes O No If so, please describe:
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ENVIRONMENT/LIFESTYLE:
List all people, including yourself, who live in your household:
Name Gender Age (of children) Relationship to you
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Who will be responsible for practicing training exercises with the dog? ______________________________________
Does your dog “belong to” a particular household member (e.g., son) or everyone? _____________________________
Do any household members dislike the dog, and if so, why? _______________________________________________
Are any household members frightened of the dog, and if so, why? _________________________________________
Is the dog frightened of any household members, and if so, why? ___________________________________________
Where is your dog kept when you are not at home? O Indoors not confined O Indoors confined: ____________________
O In yard not confined O In yard confined to dog run O In yard tied out or chained O Other: ____________________
When you are at home, is your dog allowed in the house? O Yes O No
If your dog is not allowed indoors at all, why not? O Allergies O Cleanliness O Not potty trained O We prefer it
O Destructive O Other: _____________________________________________________________________________
If your dog is an outdoor dog, would you like him to eventually be able to be indoors? O Yes O No
If indoors, is your dog ever confined (crated, penned) while you are home? O Yes O No How? _____________________
If so, how long is your dog confined on an average day? __________ Reason: _____________________________________
Where does your dog sleep at night? ________________________________________________ In a crate? O Yes O No
How many hours per day is your pet without human companionship? ___________________________________________
Do you have other pets? O Yes O No If so, what kind, breed, age, sex, neutered? ______________________________
Three
If your other petthings I like
is a dog about
or cat, mydoes
how dog:your dog get along with the otherThree things I do not like about my dog:
pet? ___________________________________
______________________________________________ _________________________________________________
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Does your dog play with toys or play games? O Yes O No _________________________________________________
If so, what are his favorite toys/games? (These may be interac-
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tive games like tug or toys he plays with alone.) ______________________________________________________________
What other activities does your dog enjoy? __________________________________________________________________
TRAINING:
O No training yet O Trained him ourselves O Puppy Group O Basic Group O Inter. Group O Advanced Group
O Private Lessons O Sent to trainer If group class, did you complete the course? O Yes O No
Training methods used (check all that apply): O Food treats O Praise O Verbal corrections O Physical corrections
List organization name and/or trainer’s name: _____________________________________________________________
Circle the behaviors your dog knows. Then, next to each, estimate what percentage of the time he will do so when asked:
Sit _______ Down _______ Stay _______ Come _______ Walk nicely on leash _______ Leave it _______
Give _____ Wait _______ Go to your place _______ Quiet ______ Off (furniture or when jumps up) ________
Others (including tricks): ____________________________________________________________________________
Check the behaviors that apply to your dog:
O Aggressive (describe below) O Fearful (describe below) O Anxious when alone
O Jumps on people O Pulls on leash O Destructive when alone
O Mouthing/nipping O Chews furniture/property O Digs in yard
O Urinates in house O Urinates when excited O Defecates in house
O Steals food/objects/trash O Darts out doors/gates O Escapes from yard
O Guards food/toys/chewies/other O Excessive attention-seeking O Jumps on furniture
O Play biting O Stool consumption O Understands but will not obey
O Excessive vocalization when alone O Excessive voc. when we’re home O Other (describe below)
O Threatening/biting family members O Threatening/biting strangers O Threatening/growling at other animals
List
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any procedures/training equipment you’ve used to try to correct the behaviors checked on the previous page:
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What would you like help with, in order of importance?
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Has your dog ever bitten anyone? O Yes O No Any animal? O Yes O No
If so, please describe in as much detail as possible: __________________________________________________________
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Has medical attention been necessary (for humans or animals) because of any aggressive incident? O Yes O No
If yes, please explain: _________________________________________________________________________________
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What is your dog’s usual reaction when a person he has not met before enters the home? ____________________________
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When was the last time a person unfamiliar to your dog entered the home? _______________________________________
Is there anything else you feel it would be important for us to know?
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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.
