CLIENT INFORMATION FORM
Today’s Date ______ / _______ / ________
Please answer the questions that follow as thoroughly as possible, and return before your appointment.
All answers are confidential and will help us to serve you better.
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Owner’s Name
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Dog’s Name
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Address
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Breed/Mix
D.O.B. or Age
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City
State
Zip
_______________ ______________________________
Weight
Color/unique markings
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Home Phone
Work Phone
O Male O Female
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Cell Phone
Occupation
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If spayed/neutered, at what age?
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Email
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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
O Intact
O Neutered
O Spayed
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?
Is your dog on heartworm preventative?
Is your dog on flea and/ or tick preventative?
O Yes O No Has he/she ever had to be muzzled? O Yes O No
O Yes O No Brand ______________________________________
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 things I like about my dog:
Three things I do not like about my dog:
______________________________________________ _________________________________________________
______________________________________________
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______________________________________________ _________________________________________________
If your other pet is a dog or cat, how does your dog get along with the other pet? ___________________________________
Does your dog play with toys or play games? O Yes O No If so, what are his favorite toys/games? (These may be interactive 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 _______
Give _____
Wait _______
Stay _______
Come _______
Walk nicely on leash _______ Leave it _______
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
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List 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.
PLEASE SEE THE FOLLOWING PAGE TO SIGN OUR CONTRACT
Classes are filled on a first-come, first-served basis. A spot will not be held until payment is received along with signed Training Agreement.
These items must be received prior to commencement of first class.
Services: Oscar Winning Behavior agrees to provide private lessons for Client and Dog on a lesson-by-lesson basis, the
goal being to teach Client how to train and work with Dog. These lessons will take place at Client's home. Oscar Winning
Behavior will make every reasonable effort to help Client achieve training and behavior modification goals but makes no
guarantee of Dog’s performance or behavior as a result of providing professional animal behavior consultation. Client
understands that he/she and members of the household must follow Oscar Winning Behavior’s instructions without
modification, work with dog daily as recommended, and constantly reinforce training being given to Dog. Payment is due prior
to the start of training. No refunds will be given after training has commenced.
Cancellation Policy: If Client fails to give at least 24 hours cancellation notice, or is not present at time of scheduled
appointment, session fees are still due. For a package deal, the session will still be counted as one session.
Liability: If Dog causes property damage, or bites or injures any dog, animal or person (including but not limited to Oscar
Winning Behavior and Oscar Winning Behavior’s agents), during or after the term of this Agreement, then Client agrees to pay
all resulting losses and damages suffered or incurred, and to defend and indemnify Oscar Winning Behavior and Oscar
Winning Behavior’s agents from any resulting claims, demands, lawsuits, losses, costs or expenses, including attorney fees. If
Dog is injured in a fight or in any other manner during or after the term of the Agreement, Client assumes the risk and agrees
that Oscar Winning Behavior should not be held responsible for any resulting injuries, losses, damages, costs or expenses.
At Oscar Winning Behavior's sole election, Oscar Winning Behavior's duties hereunder shall terminate if (a) in Oscar Winning
Behavior's sole judgment Dog is dangerous or vicious to Oscar Winning Behavior or any other person or animal, or interferes
with the training of other dogs, or (b) Client breaches any term or condition of this Agreement. Upon termination in accordance
with the foregoing, Oscar Winning Behavior's duties shall terminate but all other provisions of this Agreement shall continue in
full force and effect.
This Agreement is binding upon Client, spouse of Client, and children of Client. This Agreement supersedes all prior
discussions, representations, warranties and agreements of the parties, and expresses the entire agreement between Client
and Oscar Winning Behavior regarding the matters described above. The parties confirm that, except for that which is
specifically written in this Agreement, no promises, representations or oral understandings have been made with regard to
Dog or anything else. Without limiting the generality of the foregoing, Client acknowledges that Oscar Winning Behavior has
not represented, promised, guaranteed or warranted that Dog will never bite, that Dog will not be dangerous or vicious in the
future, that Dog will not exhibit other behavioral problems, or that the results of the training will last for any particular amount
of time. This Agreement may be amended only by a written instrument signed by both Client and Oscar Winning Behavior.
AGREED TO:
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AGREED TO:
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