Name
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First Name
Last Name
Email
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Phone
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(###)
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone
*
(###)
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Emergency Contact Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Veterinarian Name
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Vet Phone
*
(###)
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Vet Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Medical Information
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Does your dog have any medical information we should know about? (Including allergies or medications)
Dog Name
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Dog Age
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Dog Breed
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Dog Sex
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Is your dog spayed or neutered?
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What kind of food is your dog eating and how much?
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Does your dog have free access to food or does your dog eat all of its food?
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How many people are living in your home and are involved in your dog’s care? If you have children in your home please list their ages.
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How much exercise is your dog currently getting?
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How long have you owned your dog?
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What problems are you having with your dog?
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Has your dog had any formal training in the past? Was it effective?
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What methods have you tried in the past to discipline your dog or to stop unwanted behaviours?
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How do you feel about disciplining your dog?
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What kind of tools do you currently walk your dog on? (example harness, flat collar, martingale, flex leash, regular leash etc)
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What does taking your dog for a walk look like? Are they pulling? Calm? Reactive to dogs, people, bikes skateboards etc?
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Is your dog crate trained?
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If no, please explain why.
Has your dog ever broken out of its crate?
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How many hours is your dog alone during the day?
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How does your dog ride in the car?
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What does your dog do when someone rings the doorbell or knocks on the door? What do they do once the person has entered?
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Has your dog ever been away from you overnight?
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Does your dog have separation anxiety?
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How does your dog behave at the vet?
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How does your dog act around food, toys, bones or objects they find valuable to them? Do they ever growl, snap or bite when you try and take any of these items away?
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Are there other pets in the home?
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If yes, does your dog have issues with any of them?
Does your dog like or want to chase small animals such as cats or squirrels?
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Has your dog ever bitten another dog?
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If yes, please explain why.
Has your dog ever bitten a human?
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If yes, please explain why.
Is there anything else you want to tell us about you, your family or your dog you feel is important for us to know?
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What are your top three goals for your dog once their training is finished?
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How did you hear about us?
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I understand that The Structured Canine uses both rewards and discipline to train and change behaviours
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I understand that my dog must be fully up to date on vaccinations including Bordetella (the vaccine for kennel cough) This also includes up to date flea and tick medication as well. All vaccines and flea/tick medication must be administered 14 days before coming in for training.
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By submitting this form you acknowledge you are familiar with The Structured Canine’s training method, programs and prices. A non refundable 50% deposit must be made at the time of booking your training program and the remaining 50% must be paid when you drop your dog off for training.
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