Adolescent support Intake Form — Shake On It Pet Training

Your age

Names and ages of all children who live with your dog.

Email addresses

Include all email addresses of those who would like to be included in the correspondence between us.

How did you hear about Shake On It Pet Training?

Your Dog's General Information

Dogs name

Breed or breed mix

Dog's age

Dog's weight

Describe in detail the behavioral issues you are seeking help for.

What have you done to try and solve the issues yourself?

How long has your dog had these behavioral issues?

What are your goals or aspirations for your dog?

How will your dog receive me as a guest in your home?

Background and History

How long have you had this dog?

Where did you get your dog? If you acquired your dog through a shelter or other circumstance please provide any history or information you received about your dog.

If you got your dog from a breeder please provide their contact info/website if available.

Your Dog's Lifestyle

What other pets are living in your home?

If there are conflicts between your dogs you must fill out a form for each dog.

What do you feed your dog?

Dry kibble, wet food, home cooked, raw...

How many days of the week does your dog receive 30 or more minutes of moderate to strenuous physical exercise?

What kind of exercise, where, how long...

Please list what kind of mental stimulation you provide for your dog.

Please include how often you provide mental stimulation for your dog.

Your Dog's Medical And Health Information

What veterinarian do you use?

Underlying health issues are often the cause of many behavioral issues, have you discussed your dog's behavior with your vet?

List all medications and supplements your dog is taking.

List all allergies your dog has.

Your Dog's Training History

Where has your dog been trained in the past?

Organization name, trainer name

I do not use, or advocate the use of aversive training methods inc. pinch, prong, or shock (e-collars), or erroneous dominance/pack approaches. Are you open to exploring better ways to solve your dog's behavioral issues without those concepts and equipment?

Your Dog Vs. Other Dogs (Put N/A in all the fields if you are not seeking help for a dog vs dog related issue)

Describe your dog's past experiences with other dogs that they do not live with.

Describe exactly what your dog does when he/she sees another dog while on-leash.

Barks, pulls on leash, lunges, growls, air snaps, bites, hackles up, tries to hide, sniffs quietly, etc.

Describe exactly what your dog does when he/she interacts with dogs off-leash.

Barks, charges, lunges, growls, air snaps, bites, hackles up, runs away, hides, sniffs quietly, etc.

How many fights has your dog had with the other dogs in your home?

How many fights has your dog been in with dogs that do not live in you home?

Describe ALL the bites your dog has inflicted on the dogs that live in your home.

Please be specific and detailed.

Describe ALL the bites your dog has inflicted on other dogs that do not live with you.

Please be specific and detailed

Your Dog Vs. Humans

Describe exactly what your dog does when he/she encounters strangers.

Barks, charges, lunges, growls, air snaps, bites, hackles up, runs away, hides, sniffs quietly, etc.

Descrbe exactly what your dog does when a stranger tries to pet him/her.

Barks, charges, lunges, growls, air snaps, bites, hackles up, runs away, hides, sniffs quietly, etc.

Describe all the bites your dog has inflicted on a human.

Include severity, who it was, and approximate dates.

Is there anything else you would like to add?