Canine Enrichment Program Assessment Questionnaire

Personal Information

Name*

First Last

Email*

Phone*

Please provide cell # if available.

May I text you at the number above?*

Yes
No

Address

Street Address City State ZIP Code

About Your Dog

Dog's Name*

Dog's Age*

Dog's Sex*

Male
Female

Dog's Weight*

Spayed / Neutered*

Yes
No

Dog's Breed/Mix*

Where did you get your dog?*

Breeder, rescue, shelter, as a gift, etc.

How long has your dog been with you?*

Dog Behavior

Do you have any behavioral concerns for your dog?*

Yes
No

Please list your top 3 concerns*

Have you worked with another trainer with the dog listed above?*

Yes
No

What company?*

Can you tell me anything about that experience that might be important?

Dog Behavior Details

Please check the areas your dog needs help with.*

Check all that apply

What type of daily exercise does your dog get?

Is your dog currently on any medications?

Yes
No

For what and for how long?

Is your dog prone to or recovering from any injuries?

Yes
No

Please explain

Is your dog crate trained?

Yes
No

Do you walk your dog?

Yes
No

Does your dog pull on the leash?

Yes
No

What kind of leash/collar/equipment do you currently use or have ever used?

Check all that apply

Harness (leash attaches to chest)
Harness (leash attaches to back)
Head collar/halter (Halti, Gentle Leader, etc.)
Belt collar (regular flat collar)
Chain collar
Prong collar
Remote/electronic collar
Perimeter collar (electronic collar to keep dog on property)
Off leash

When you walk your dog and he sees another dog, does he:

Check all that apply. If different for each dog, select other and specify

Ignore the other dog
Show some interest but keeps walking
Growl and show aggression (e.g. lunges)
Growl and tries to get away or hide behind you
Wag his tail in a playful manner and want to play
Pull hard to get to the other dog in a not-so-friendly way
Other

Please explain

When you walk your dog and he sees a cat or other small animal, does he:

Check all that apply. If different for each dog, select other and specify

Ignore the cat/animal
Show some interest but keeps walking
Growl and show aggression (e.g. lunges)
Growl and tries to get away or hide behind you
Wag his tail in a playful manner and want to play
Pull hard to get to the other animal in a not-so-friendly way
Other

Please explain

Does your dog allow you to 'examine' him?

(Touch his feet, look in his ears, check his teeth, etc.)

Yes
No
Sometimes

Does your dog allow you to groom him?

(Clip his nails, brush him, etc.)

Yes
No
Sometimes

Does your dog allow you to take away a high-value or forbidden item?

E.g. a bone, a toy, a sock he found on the floor.

Yes
No
Not sure

Has your dog ever had obedience training?

Yes
No

Please describe the type of training.

e.g. group classes, private lessons, board-and-train

Are you opposed to using any of the following training tools?

Check all that apply

Treats
Clicker
Head collar/halter (Halti, Gentle Leader)
Chain collar
Prong collar
Electric collar
I am not opposed to any of the training tools mentioned

What motivates your dog?

Check all that apply

Food
Affection/Praise
Play
Not sure

Please select the commands that your dog can perform reliably and consistently.*

He doesn't know any commands
Sit
Down (Lay Down)
Recall (Come or Here)
Place
Heel (Loose Leash Walking)
Leave-It
Other

Please list any other commands that your dog knows.

Is there anything else about your dog or your training goals that you want us to know?

CAPTCHA

Comments

This field is for validation purposes and should be left unchanged.