Canine Enrichment Program Assessment Questionnaire Personal InformationName* First Last Email* Phone*Please provide cell # if available.May I text you at the number above?* Yes No Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code About Your DogDog'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 BehaviorDo you have any behavioral concerns for your dog?* Yes No Please list your top 3 concerns*Dog Behavior DetailsWhat 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 explainIs 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 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 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 that you want us to know?CAPTCHAEmailThis field is for validation purposes and should be left unchanged. Δ
