Form - Simply K-Nine

Name

First

Last

Email

Phone number

Address

What's your dog's name

What's your dog's age

What's your dog's gender?

It’s a girl!
It’s a boy!

Where did your dog come from?

Animal Shelter/Breeder/Found as Stray/Internet (Craigslist etc.)

How long have you had this dog?

Have you had previous dog experience?

Yes
No

What breed is your dog?

Why did you choose this breed?

Why did you choose this particular dog?

Who is your veterinarian?

Is your dog current on vaccinations?

When was your dog's last veterinary exam?

Does your dog have any known medical problems?

Is your dog on any type of medication?

Is your dog spayed/neutered?

Yes
No

Does your dog have food allergies?

If so, please specify

What type of food is your dog being fed?

Dry kibble/Raw food/Canned food/Home made dog food/People food

How many times a day is your dog fed?

Once a day
Twice a day
More than twice a day
I keep his/hers food bowl always full

What type of treats your dog gets and how often?

For example – Bully sticks/Milk bones/Training treats/Dog cookies/etc.

Do you feed your dog on a schedule? If so, at what hours?

Does your dog eat right away and finishes the entire meal?

Where is your dog fed and who is nearby when he/she eats?

Who does the feeding?

Does your dog get people food?

Where does your dog sleep?

Is your dog allowed on furniture?

Yes
No

Where does your dog eliminate?

Where is your dog kept when no one is home?

For what period of time is your dog left alone?

Please enter the average per day

What percentage of time does your dog spend indoors vs outdoors?

Does your dog have any previous training?

If so, please describe familiar cues, training methods and who did the training

What tricks does your dog know?

Describe how you correct your dog's unwanted behavior

For example: Verbally – No! Eh-eh!/Using water spray/Slapping with newspaper, slipper/Slapping with palm/etc.

Describe how you reward your dog for wanted behavior

For example: Verbal praise/Hugging/Patting on head/Food reward/etc.

What would you like to change about your dog's behavior?

Is your dog housebroken?

Yes
No

Is your dog crate trained?

Yes
No

What type of exercise does your dog receive?

What are 3 of your dog's most favorite treats?

What are 3 of your dog's most favorite toys or games?

What is your dog's most favorite activity?

What is your dog's least favorite thing?

Can family members handle your dog physically?

Fox example: Bathe/Trim nails/Reposition without biting or being growled at

Do you plan to do any type of competition, dog sports or therapy activities with your dog?

Are you interested in behavior modification?

Yes
No, just the Puppy Training
No, just the Basic Obedience Training

**If you’ve picked “Yes”, please continue with the questions below. – If you’ve picked any other option than “Yes”, please Submit your Questionnaire now**

Can you describe the problematic behavior?

When did the behavior first occurred?

Were there any changes in the household when the behavior first occurred?

How often does the behavior occur?

Under what specific circumstances does the behavior occur?

In what locations? Who is present?

Has the frequency and the intensity of the behavior changed?

Does it occur more often than it used to? Is it getting worse (stronger, more intense) than it used to?

When was the most recent incident?

What is your reason for seeking help now?

What has been done so far to address the problem?

How much time and effort are you willing to spend on resolving this issue?

Have you considered the options, should the issue not be solvable?