Private Consultation Questionnaire Email First Name * Last Name * Home Phone Cell Phone Street Address * City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa 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 Zip Code Email Address * Home Environment * Non-smoking in the home Smoking in the home Are those eligible in your home fully vaccinated for Covid 19? * Yes No Household Members (Humans) - Names and Ages Other Pets Living in the Home (Species, Name, Age) Dogs Name Breed / Mix Dogs Age Dogs date of birth (*this field does not work with SAFARI or IE) Gender Information Male Female Spayed / Neutered Intact Dogs Weight Age of Spayed / Neutered? Where did you get your dog? How old was your dog when you got him/her? What brand and type of food do you feed your dog? Amount per meal? Times per day? Veterinarian: Medications your dog is currently taking: Current medical issues? Previous medical conditions? What is the reason for your contacting Animal Manners? When did these issues begin? (please be as specific as possible) How often do these problems occur? (be as specific as possible) Training attempts to resolve problem(s)? If yes, please describe in detail: when, where, with whom and what you learned. Type of discipline. management, training etc What was the dog’s response to the above training attempts? (check all that apply) Better Worse Remained the same Type of Class / Course you are looking for (check all that apply) : Puppy Manners Adult Manners Beyond Manners Parent Education Private Consultation What vocabulary words does your dog currently understand? (example: sit, lie down, stay, etc) Previous Training:(check all that apply) No training yet Trained him/her ourselves Puppy Group Basic Group Intermediate Group Advanced Group Private Lessons Sent to Trainer Please describe the training tools used: (check all that apply) * Flat Collar Body Harness No-pull Harness Head Halter Martingale Choke/Slip Collar Prong/Pinch Collar E-Collar Invisible Fencing Physical Fence Tether Baby gates X-Pen Long-lines Crate How much, and what type of exercise does your dog get per day? Does your dog attend doggie daycare or have a dog walker? If yes, how many days / hours per week? How many hours is your dog left home alone per day? Is your dog free in the house, crated, other? How would you describe your dog experience level? First time owner Somewhat experienced Experienced What are your goals for this dog? Where did you hear about Animal Manners? What is your preferred day and time for our training session? Monday(daytime only), Tuesday(day/evening), Wednesday(daytime only), Thursday (day/evening), Friday (daytime only): * Hours: 9:00am to 7:00pm: *
