| First Name: * |
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| Last Name: * |
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| Mailing Address: * |
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| City: * |
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| State: * |
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| Zip: * |
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| Phone: * |
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| Alternate Phone: |
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| Email: * |
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| How did you learn about All Dawgs Training Services? * |
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| How would you like to receive our quarterly newsletter?: |
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| What is the name of your vet clinic's name?: * |
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| May we share information with your vet regarding this issue?: |
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Dog Information
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| Dog's Name: * |
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| Dog's Date of Birth: * |
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| Dog's Breed: * |
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| Dog's Sex: * |
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| Is this dog spayed or neutered?: |
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| Where did this dog come from?: |
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| If other, please explain: |
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| How old was this dog when he/she came to live with you? * |
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| Does this dog have any medical issues?: |
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| If yes, please explain: |
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| Does this dog have any known allergies?: |
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| If yes, please explain: |
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| Can you take this dog's food bowl away?: |
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| Can you take chewies, toys or treats away from this dog?: |
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Aggression Information
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| How long has this been an issue?: * |
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| Why are you seeking to address this issue now? * |
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| Was this dog exposed to other dogs as a puppy?: |
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| Are there other dogs in the home?: |
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| If there is another dog in the home, is this dog's behavior different when the other dog is present?: |
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| If there are other dogs in the house, does this dog fight with them?: |
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| Are there other dogs (other than your own) that this dog currently plays with or with whom he is comfortable around?: |
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| When this dog is taken for a walk, what is the dog's reaction to ther dogs? Describe physical reaction as specifically as possible.: * |
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| In what percentage of exposures to other dogs does this reaction occur?: * |
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| At what distance from other dogs does this reaction occur? * |
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| Is this dog's reaction more intense when encountering specific characteristics in another dog (i.e. male, female, neutered, intact, small, prick-eared, etc)?: |
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| If yes, what characteristics prompt this behavior?: |
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| Does the dog's reaction differ depending on which family members are present and/or who is at the end of the leash?: |
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| If yes, how is the dog's reaction different?: |
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| Would you say this behavior has become more frequent and/or intense or stayed the same?: |
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| If more frequent or intense, since when?: |
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| If more frequent or intense, was there a specific incident or circumstance that preceeded or coincided with this increase?: |
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| Does your dog "warm up" to other dogs with repeated exposures?: |
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| Has this dog ever fought with another dog?: |
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| If this dog has been involved in a fight, how many incidents have there been?: |
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| If yes, please describe the incident(s): |
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| Have you worked with another trainer on this issue?: |
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| If yes, who have you worked with in the past on this issue?: |
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| What has been done to address the issue so far (either with another trainer or on your own)? Describe results: * |
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| Please give any other information that might be helpful: |
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| By initialing this box, I affirm that the above information is accurate to the best of my knowledge:: * |
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