Puppy Consult Questionnaire Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Who can we thank for referring you to us? Please list the other HUMAN members of your household including their names. If children reside with you, please also include their AGES. Who is your puppy's veterinarian? * Veterinary Information Veterinarian's Phone Number * (###) ### #### Dog's Information Dog's Name * Dog's Birthdate * Dog's Breed * Dog's Weight * Dog's Sex * Where did you get your puppy? If applicable, please include the name of the breeder, shelter or rescue. * How old was your puppy when you adopted it? * Is your puppy spayed/neutered? * Yes No If yes, at what age was your puppy spayed/neutered? How many Distemper/Parvovirus vaccines shots has your puppy received? These shots have different names depending on your vet, and may be listed as DHPP, DA2PP, DHLPP, or DALPP. * Please list all other PETS in your home, including their SPECIES, AGE, SEX, and whether they are SPAYED/NEUTERED. Describe your dog's daily routine. * What are your dog's favorite activities and/or toys? * What kind of food are you currently feeding your dog for meals? Potty training How often does your puppy soil OUTDOORS each day? How often does your puppy soil INDOORS each day? * When your puppy soils indoors: What time of day is it? Are you home or away? * What potty training measures have you taken so far? Do you have a crate for your puppy? * Yes No If you answered yes, how have you used the crate so far? How has your puppy responded to the crate? Socialization How many NEW PEOPLE does your puppy meet each week? * How many NEW DOGS does your puppy meet each week? * How many NEW PLACES does your puppy visit each week? * Is your dog enrolled in a puppy class or puppy social group? If yes, where? * If your puppy already has some trained skills, please list those here. (e.g. sit, lay down, recall, walking on leash, stay, shake, bow, go to crate) What do you like best about your dog? What specific goals do you wish to accomplish through training? Is there anything else you'd like to share? Thank you!
