3-session Assessment Package

First Name *

Last Name *

Full Address: *

Mailing Address (if different):

Cell Phone:

Home Phone:

I can send and receive text messages on my cell phone. Note: text messaging is the fastest way to reach me and the best way to get updates on changes! *

In order of preference (1st, 2nd, 3rd), please list your preferred method (Text, Email, or Phone call) for us to communicate about scheduling, questions, and concerns about your dog.

Please list best days ( Monday through Sunday) and times (morning or afternoon) for your dog's training sessions. And state what time is too early for you.

Your Occupations:

How did you hear about us? *

If referred by a Lucky Leash client or a Veterinarian, please tell us their name so we can thank them.

Please list names of other adults who may be involved in the training of your dog:

Please list names & ages of children in your family who interact with your dog:

If you are vegetarian or vegan, please check one of the following for working with treats for your dog:

Dog's Name: *

How old is your dog? (or best guess) *

How long have you had this dog?

Breed (best guess if mixed) *

Color/Markings:

Dog's weight (or best guess)

Your Goals: In 3 brief sentences, list your dog's 3 top behaviors you want to change/work on during our time together: *

For each of the 3 behaviors (goals) above, list at least 2 behaviors that you would you want your dog to do instead: *

Where did you get your dog: *

Do you have information about your dog's history before you adopted? If so, please give brief details.

Was your dog the only puppy in a litter? *

How old was your dog when you adopted? *

If your dog was in a Shelter or Rescue, do you know how many times the dog has previously been adopted? Do you know why the dog was returned?

Why did you choose this dog? *

Did you research the characteristics and temperament of this breed before choosing this dog? *

Dog's gender: *

Do you know if your dog's parents or siblings showed behaviors similar to those you see in your dog?

List all other animals in your household, their names, their species, breed, age, gender and whether or not they are neutered. Please indicate which of these animals were living in your home when you adopted your dog.

Describe interactions between your dog and any other animals in your home.

Please describe a typical day (from wakeup to bedtime) in the life of your dog. If you have multiple dogs with different routines, name each dog and describe any substantial differences.

Please describe the daily rules and structure you have for your dog? (If none, just say None)

How do you plan to include daily/weekly training into your already busy lifestyle? For example, frequency, times of day, duration, location, etc. *

Describe friendly or unfriendly interactions between your dog and family members.

Have you moved recently?

If your dog has had any interactions with Animal Control, please describe:

What prompted you to seek help today? Was there an incident that was "the last straw?" Please describe. *

When did you first notice the behaviors that concern you. How old was your dog at the time? *

List all discipline methods have you tried so far to solve the problem, and what was your dog's response? Are you still using this/these methods?

Which of the following does your dog do willingly (check all that apply) *

In what situations might your dog be unwilling/unable to perform those behaviors? Example: dog park, crowded public area, vet office, etc.

Vet's Full Name:

Vet/Clinic's Full Address:

Vet/Clinic's Phone Number:

Is your dog up to date on all shots? *

Please upload proof of vaccination: *

Date your dog's rabies vaccine expires? *

Does your dog have any health problems (that you know of)? *

Have you talked with your vet SPECIFICALLY about your dog's behavioral problem? *

Please list any medications & why and how long your dog has been on the medications:

Vet visits - Describe your dog's behavior in the 1) vet office lobby and 2) during an examination. *

List the type/brand of food you feed your dog and how many times per day.

Has your dog's appetite:

List typical treats you give your dog:

List any allergies to food, medications, environmental conditions that your dog has that you are aware of:

Which of the following training classes has your dog attended?

Have you previously worked with a trainer, veterinarian, or veterinary behaviorist for help with your dog's behavior problems? What recommendations were given? Was there any improvement? Did the behavior become worse?

What motivates your dog - food? chasing things? toys? playing with other dogs? walks? car rides? fetch? tug? or other?

Does your dog ever seem irritated by petting? Does your dog seem resistant to petting?

Does your dog bark excessively? If so, under what circumstances?

How does your dog behave in a vehicle?

Describe your dog's behaviors around strangers? *

Describe your dog's behaviors around unfamiliar dogs? *

Does your dog cower or run away if people talk loudly or act differently? *

Is your dog comfortable in crowds? *

How does your dog act when a stranger comes to your house? *

How does your dog act when he meets or passes strangers while away from your house? *

List all things that you think your dog is frightened by: *

Does your dog chase any of the following: Such as cats, bikes, kids, cars, etc.

How many hours per day (on average) is your dog without human companionship? *

How do you exercise your dog? how often (rain or shine)?

What equipment do you use to walk your dog? *

Consider your last ten walks with your dog. How many of those walks were peaceful and pleasant? *

Consider your last ten walks with your dog. How many of those walks were stressful and frustrating? *

If your dog has access to fenced yard, what type of fencing is it?

Does your dog fence-fight with neighboring dogs?

What toys does your dog have? Which are his/her favorite toys?

Can you easily take toys away from your dog? *

Is your dog crate-trained? *

Where does your dog sleep at night?

Where is your dog when you have familiar guests?

Where is your dog when you have unfamiliar guests?

Where is your dog when he/she is alone in the house?

Touch dog's food or add food while eating *

Walk past dog while dog is eating *

Take away real bone, rawhide, or delicious food *

Touch delicious food while dog is eating *

Take away a 'stolen' object *

Walk by dog in his/her crate *

Walk by or talk to dog on furniture *

Remove dog from furniture, physically or verbally *

Pick your dog up *

Reach for your dog's collar or leash *

Does your dog seem upset or anxious when you leave him/her alone? *

Has your dog bitten or attempted to bite a human? Please describe each incident, being as specific as possible *

Have you specifically taught your dog to be comfortable wearing a muzzle?

Do you take your dog to off-leash dog parks? If so, how often?

Does your dog attend doggie daycare?

If your dog does attend doggie daycare, which one, how long has he/she been going, and how many days per week?

Does your dog play well with other dogs and/or have doggie friends?

Has your dog attacked or bitten a DOG? Please specify if KNOWN or UNKNOWN DOG was bitten, WHEN, WHERE it happened and WHAT were the circumstances? If more than one incident, please list the 3 most recent. *

Has your dog ever been ATTACKED by another dog? If yes, please describe the incident. Was your dog treated by a vet? *

How do you feel about your dog's problem behaviors? *

For Intra-household dog-dog fighting, please list all events/times when your dogs do not fight and seem to enjoy being together (examples might be sleeping together, going on walks together, etc.)

For intra-household dog-dog fighting, please list all environments where you know fights have occurred. Also list whether any humans or resources were present at the time of the fights.

A very important part of training is being able to see what you do and what your dog does. Thus, taking videos are a critical part of your success in training. Check the box below to confirm your agreement to take and submit weekly video clips to your instructor for feedback. *

Please read and sign the client agreement below to begin our working relationship! *

Signature required

One last thing... please submit a photo of your dog to me! :)