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Evaluation Form
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Current Owner Details
Name
*
First
Last
Email
*
Phone
*
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
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Indiana
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Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Pet Details
Name
*
Breed(s)
*
Weight
*
Age (use months up to 24)
*
Where did you obtain your dog?
Breeder
Online Rehome
Shelter/Rescue
Friend/Relative
Found Stray
Other
Age YOU Adopted
*
Brief history of your dog
Other pets in the home?
*
Yes
No
Up to Date on Shots
*
Yes
No
Not Sure
Spayed/Nuetered
Yes
No
Not Sure
Behavior on leash (choose worse)
*
Walks Nicely
Pulls
Reactive towards Squirrels/wildlife
Reactive towards Dogs
Reactive towards People
Aggressive towards Dogs
Aggressive towards People
Other (please explain)
Behavioral Concerns towards dogs
*
None- Friendly
Not socialized
Leash reactivity
In home aggression
Possessive aggression
Unknown aggression
Behavioral Concerns towards People
*
None- Friendly
anxiety/Fearful
Leash reactivity
Possession of food, toys, beds
Barking/aggression with guests
Other Behavioral Concerns
*
Barking/aggression with other animals
Excessive barking in home/yard
Separation anxiety
Crate training
Possession of food, toys, beds
Potty Training
Jumping up
Destructive chewing
Chasing bikes / runners / cars
Behaviors have gotten
*
Worse or more severe
Stayed the same
Better or less frequent
Bite history with DOGS?
*
has NEVER growled/snapped or bite
has growled/snapped but NO bite
bite occurred
bite required medical care
Bite history with PEOPLE
*
has NEVER growled/snapped or bite
has growled/snapped but NO bite
bite occurred
bite required medical care
Any prior professional training?
When you leave your dog at home unattended they are....
*
Crated
Out in House
Outside
Garage
Training Goal's. Tell us anything we should know.
*
Prefered Training Route
*
Training Sessions
Board & Train
Undecided
Days available for training sessions
Times available for training sessions (Mornings, Afternoons, Evenings)
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