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Dog Training Intake form for Furry Godmother, LLC
Please complete this form if you interested in working together on training.
First and Last Name:
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Phone Number:
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Email Address:
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Home Address:
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What is your dog's name?
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Additional dogs:
Please upload a photo of your pup(s)
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Click to choose a file or drag here
Size limit: 10 MB
Doggie #2
Click to choose a file or drag here
Size limit: 10 MB
Doggie #3
Click to choose a file or drag here
Size limit: 10 MB
Doggie #4
Click to choose a file or drag here
Size limit: 10 MB
What gender are your dogs?
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What breed are your dogs?
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Are your dogs spayed/neutered?
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Are your dogs spayed/neutered?
A
Yes
B
No
What motivates your dog(s)?
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What are your dog's ages?
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I am required to confirm proof of vaccination. Please upload their latest records.
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Click to choose a file or drag here
Size limit: 10 MB
Records for additional dogs:
Click to choose a file or drag here
Size limit: 10 MB
Click to choose a file or drag here
Size limit: 10 MB
Click to choose a file or drag here
Size limit: 10 MB
How did you become the owner?
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How did you become the owner?
A
Shelter adoption
B
Found in the wild
C
Given by someone else
D
None of these
I became the owner a different way. Describe.
Has your dog(s) had any past/current medical issues or medical concerns? Y / N and explain.
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Does your dog have any allergies including environmental or food-related?
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Please let me know if there are any accommodations you would like me to make so that it's easier for you to participate in training with your dog.
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Select any that apply.
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Select any that apply.
fearful dog
jumping
anxious when alone
accidents in the house
darting/escaping doors or gates
urination when excited
difficult walks
destructive when alone
biting
Resource guarding
anxiety
aggression towards dogs
counter surfing
aggression toward people
What kind of challenges are you facing with your dog? Tell me what specific issues you want to work on together.
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What have you tried so far to resolve these issues?
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Select the option that is most applicable.
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Select the option that is most applicable.
A
I would like to change problem but it is not serious.
B
he problem is serious and I would like to change it, but if it remains unchanged that’s all right.
C
The problem is very serious and I would like to change it, but if it remains unchanged I will keep my dog.
D
The problem is very serious and I would like to change it; if it remains unchanged I will have my dog euthanized or give him/her up.
E
I have almost given up already and am seriously considering having my dog euthanized or giving him/her up.
Has your dog(s) ever bitten anyone or broken skin?
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Would you consider your dog to be aggressive? If so, why?
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Has your dog ever been bit by another dog?
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Have you in the past or are currently considering surrendering your dog?
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Have you worked with a trainer before? If so, what was the outcome of that training?
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Are there other animals in the home? Please share any notes about the relationship between them (both at home and outside of the home.)
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How much exercise does your dog get on a daily basis?
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How much exercise does your dog get on a daily basis?
A
30 mins
B
1 hour
C
2 hours or more
Describe the different activities your does to get exercise.
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Is there anything additional you would like me to know?
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How many sessions are you thinking about doing?
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How many sessions are you thinking about doing?
1 session ($150/hour)
3 session package ($450)
6 session package ($900)
9 session package ($1,350)
Based on your current schedule, when would be the ideal time to do training sessions together?
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Based on your current schedule, when would be the ideal time to do training sessions together?
Weekday mornings
Weekday afternoons
Weekend evenings
Weekend mornings
Weekend afternoons
Weekend evenings
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