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    Note: Please fill out the fields marked with an asterisk*

    YOUR INFORMATION

    First Name*

    Last Name*

    Introductory Message*

    Email*

    Phone*

    Type* CellHome

    Preferred Contact Method* PhoneEmailText

    Address*

    Number of people in household*

    Names of other adults in Household

    Children still at home, names and ages

    DOG'S INFORMATION

    Dog's name*

    Dog's age*

    Dog's weight (approx)*

    Dog's sex* MF

    Spayed/Neutered?* SpayedNeutered

    Dog's breed or mix*

    How long have you had your dog?*

    Where did you get your dog?* RescueShelterBreederFriend/AcquaintanceOther

    Shelter, rescue or breeder name

    Dog's age when acquired

    What information, if any, do you have about his/her previous life?

    Other animals in household

    Your experience level* First time ownerSomewhat experienced (have had a few)Very experienced

    Please describe your dog's behavior problems, in as much detail as you wish*

    How often and in what context do the behavior problems occur?*

    What has been done to work on the problem(s)?*

    Do you know whether your dog ever suffered a traumatic event? An attack by another dog or an issue with a human? If so, please explain

    Veterinarian*

    Does your dog have any known physical problems?*

    Is your dog on any medication? If so, please list them*

    What kind of food do you give your dog?*

    Where does your dog sleep?*

    What kind of exercise does your dog get on a daily basis?*

    Has your dog had any formal training?* NoBasic ClassesAdvanced or Specialized ClassesPrivate Trainer in homeBoard and Train

    Does your dog go to daycare or have a dog walker?*

    Activities and food your dog likes*

    How long is your dog typically left alone?*

    What makes your dog get excited?*

    What are your goals for your dog?*

    Where did you hear about our services?