Assessment Form

Name

Last Name

Email

Do you live in San Diego Do you live in San Diego Yes No

If not what city and state List city and country if you reside outside the United States

If yes what neighborhood

What type of home do you live in What type of home do you live in Apartment Complex House with Yard House with No Yard Other

What application do you prefer to do the online video consultation What application do you prefer to do the online video consultation Skype Zoom FaceTime

What service are you interested in What service are you interested in Consultation stand alone service Consultation Online Classes Not sure would like a recommendation

Dogs Name

Dogs Age

Dogs Breed approx weight for mixed breeds

Gender GenderMaleFemale

Spayed or Neutered Spayed or NeuteredYesNoSoon

Where was the dog acquired Where was the dog acquiredBreederRescueShelterFriend Family or AcquaintanceOther

How long have you had the dog

Health Concerns

Do you have more than one dog that needs training Do you have more than one dog that needs trainingYesNoGood Question May Be

Names of people that have regular contact with dog, provide age and relation if under 18

Do you have other pets

Where does dog stay when home alone Where does dog stay when home alone Free Range Inside Crate He is never home alone Limited access to house Outside

Where does dog stay during day Where does dog stay during day Free Range Inside Tethered to me to assist in potty training Limited access to house Outside

Where does dog stay at night Where does dog stay at night Free Range Inside On human bed mostly Crate Limited access to house On dog bed mostly Outside

Is your dog crate trained Is your dog crate trained Yes loves the crate Attempted crate training No prefer not to use crate Tolerates the crate No longer uses crate Would like to crate train not sure how to get started

Any previous training Any previous training Yes group class Yes private lessons advanced Nope but he ready to learn Tolerates the crate No longer uses crate Would like to crate train, not sure how to get started

Does your dog go on daily walks

On walks do you use a collar or harness On walks do you use a collar or harness Front clip harness clips on dog chest Head Halter fits on dog's head Martingale collar Pinch or prong collar Regular harness clips on dog's back Regular collar Slip or choke collar Other

Allowed on Furniture Allowed on Furniture Couches Beds Only with Invitation Not allowed on furniture

What type of food does your dog eat

Does your dog have food allergies

Feeding Schedule Feeding Schedule Free Fed Schedule eats everything Schedule grazes

Is your dog social with unfamiliar people Is your dog social with unfamiliar people Seems to love just about every person Good with unfamiliar kids Selective Exhibits fearful, reactive or aggressive with unfamiliar people Good with unfamiliar women Good with unfamiliar men Tolerant okay in their presence just doesn't like to be pet by strangers Not sure

When guests enter my home, my dog When guests enter my home, my dog walks up to greet guests jumps barks but settles quickly whines hides charges guests threatens to bite is in a crate is in another room I am not sure, dont have many guests ignores guests barks a few times barks non stop wiggles pees involuntarily growls has bitten is behind a gate or in an exercise pen is outside

Has your dog ever bitten a person not including play mouthing biting Has your dog ever bitten a person not including play mouthing biting No My dog has growled but never bitten Yes the bite bruised the skin Yes the bite left a deep puncture Yes the bite left multiple puncture wounds Not to my knowledge Yes but it left no mark Yes the bite left a shallow puncture Yes the bite tore the skin Yes my dog has bitten multiple times

Is your dog social with unfamiliar dogs Is your dog social with unfamiliar dogs Seems to love just about every dog Good with small dogs Selective Exhibits fearful reactive or aggressive behavior with unfamiliar dogs Good with big dogs Good when off-leash only Tolerant okay in their presence just doesn't want to be sniffed Not sure

Has your dog ever bitten another dog not including play mouthing biting Has your dog ever bitten another dog not including play mouthing biting No Not to my knowledge I am not sure if it was play or aggression My dog has growled but never bitten Yes but it left no mark Yes the bite bruised the skin Yes the bite left a shallow puncture Yes the bite left a deep puncture Yes the bite tore the skin Yes the bite left multiple puncture wounds Yes my dog has bitten multiple times

Food Drive Food Drive High Medium Low Depends Not Sure

Toy Drive retrieving or playing tug with people Toy Drive retrieving or playing tug with people High Low Medium Depends My dog only plays with other dogs

Check issues that you would like to discuss with Trainer Check issues that you would like to discuss with Trainer House training Jumping on people Excessive Energy Fearful Behavior Separation Anxiety Aggressive behavior with people Resource guarding food toys people space with people Stealing food Submissive excitement urination Barks on leash at dogs Barks on leash at moving objects bicycles skateboards Destructive tendencies Behavior with guests Excessive Barking Anxious Behavior Aggressive behavior with dogs Resource guarding food toys people space with dogs Runs away Demands attention Pulling on leash Barks on leash at people Barks on leash at wildlife

How do you reinforce desirable behavior How do you reinforce desirable behavior Praise Food rewards Toy rewards Life rewards walks sniffing playtime

Specify Other

How do you address undesirable behavior ie jumping barking How do you address undesirable behavior ie jumping barking Interrupt Verbal reprimand Correction with training collar Redirect Physical reprimand Other

Referred by Referred by Humane Society Preferred Partner Council for Certified Professional Dog Trainers San Diego Dog Training Directory Website Referred by vet Second Chance Dog Rescue Youtube Association of Pet Dog Trainers Website Referred by family or friends It's the Pits Pit Bull Rescue Google Search Other

It's ideal to begin training shortly after consultation meeting once each week. If you plan to move forward with training are you able to start within 1-2 weeks of consult It's ideal to begin training shortly after consultation meeting once each week. If you plan to move forward with training are you able to start within 1-2 weeks of consult Yes No I have travel plans or other commitments I plan to do consult as stand alone service

Anything else you would like us to know