New Client Questionnaire Section 1: Owner Information Name * First Name Last Name Email * Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Section 2: Dog Information Dog's Name * Age * Weight * Breed * Sex * Male Female Spayed / Neutered * Yes No Where Acquired (e.g., breeder, shelter, friend) * Date of Adoption * Section 3: Health Information & Vaccinations Rabies * Yes No DHPP/DAPP * Yes No Bordatella (Kennel Cough) * Yes No Any other health concerns or past surgeries etc.? * Yes No Is Your Dog Taking Any Medications or Supplements? * Yes No Vet Clinic & Veterinarian's Name * Section 4: Nutrition / Feeding Information Manufacturer, Brand Name & Protein (e.g., Blue Buffalo Chicken & Rice) * Feeding Amount and Schedule (e.g., 1 cup twice daily) * Do You Leave Food Down All Day? * Yes No How Often Do You Use Treats and for What Purpose? * Any Food Allergies/Dairy Sensitivities? * Yes No Section 5: Household Information Do You Have Any Other Animals in The Household? * Yes No Other Members Living in Household (Include ages of children, if applicable.) * Have You Moved or Made Home Renovations in the Past Year? * Yes No Section 6: Training & Behavior Is Your Dog Crate Trained? * Yes No Is Your Dog Potty Trained? * Yes No Have You Taken Any Formal Training Classes? (e.g. PetSmart, NHS, Private Trainer) * Yes No Have You Training Done Personally? * Yes No What Do You Do When Your Dog Misbehaves / Doesn't Listen? * Please List Any of the Following Tools You Currently or Previously Have Used: Coin Shaking Can, Prong Collar, Choke Chain, E-Collar / Shock Collar, Bark Collar, Citronella Collar, Spray Bottle, Extendable Leash / Flexi Leash, No-Pull Harness, Regular Harness, Head Halter (Gentle Leader) - IF NONE OF THESE PUT NA or NONE * Behaviors / Tricks Your Dog Knows? (e.g., sit, down, come, roll over, wait at the door, loose leash walking, etc.) * Behavioral Qualities You Like: * Behavioral Qualities You Dislike (include what you want to focus on fixing) * What are things that your dog reacts to? (e.g., doorbell, other dogs, mailman, cars, loud noises) * Has Your Dog Ever Nipped/Bitten a Person or Another Animal Before? * Yes No Section 7: Lifestyle, Exercise & Activities How Often Does Your Dog Go on a Walk and Who Walks Your Dog? (If you use a professional dog walker please indicate) * What Other Exercise Activities Does Your Dog Do, How Often, How Long? (e.g., fetch 30 minutes 3 times per week, swimming once per month, hiking weekly for a couple hours, running nightly for 30 minutes, etc.) * Activities Away From Home WITH YOU (e.g., Walking in the park, hiking, visits to Home Depot / PetSmart) * Does Your Dog Go to Daycare or Dog Parks? * Yes No Home Many Hours Does Your Dog Spend Alone Each Day? * Where Is Your Dog When They're Home Alone? (e.g., in a crate, on their bed) * Where Does Your Dog Sleep at Night? * How Much Time Does Your Dog Spend in Your Yard Alone (per average day) * Section 8: Your Dogs Favorite Things What Are Your Dog's Favorite Toys and Do They Have Unlimited Access to Them? * What Are Your Dog's Favorite Treats? * Other Favorite Things (e.g., zoomies, riding in the car, sniffing, sleeping, friends visiting, dog buddy down the street) * Section 9: Additional Notes Please List Any Other Pertinent Information You Want Me to Know Thank you!
