Canine Connection Form - Crawford Canine Connection

Connecting With You

Owner Name(s)*

Other Members in Household

How did you hear about Crawford Canine Connection?

Address

Street Address City State Zip

Phone

Email*

Are you requesting remote training services?

Yes
No

Do you have access to device(s) to allow video capability?*

Yes
No

What types of devices do you have access to?

Mobile Phone
iPad
Laptop
Other

Do you have reliable internet access to allow online live training sessions?

Yes
No

(The trainers at CCC utilize Zoom.us to arrange remote live training sessions with the client and their dog.)

During the in-home consultation, various treats or foods may be given to your dog during the assessment. Are there any food related allergies to any of the humans in the home?

Yes
No

Please list food allergies:*

Connecting with Your Dog

Dog's Name

Breed

Gender

Male
Female

Age and Weight

Neutered or Spayed?

Yes
No

Age When Neutered or Spayed

Current Veterinarian

How long has the dog been part of your family?

Where did you get your dog?

Is your dog on any medications?

Yes
No

Please list medications:

Does your dog have any health issues?

Yes
No

Please list health issues:

Are there other dogs in your household?

Yes
No

Other Dogs

Do the dogs in your household get along?

Are there other pets in the household-cat, rabbit, etc.?

Yes
No

How is the interaction between the other pets and your dog?

History and Lifestyle

Have you had other dogs in the past?

Yes
No

Please share this past experience.

Has your dog had prior training?

Yes
No

What type of training?

positive reinforcement or clicker training
balance of positive and negative reinforcement
negative reinforcement

Where or with whom did you train?

Can your dog:

sit
stay
come when called
respond to name
walk politely on leash

Types of rewards used when training?

Types of corrections used when training?

Select the words that best describe your dog:

My dog will let me:

trim their nails
clean their ears
approach the food bowl
take away a toy or food

Where does your dog sleep at night?

Where is your dog when no one is home?

Is your dog crate trained?

Yes
No

What do you feed your dog, and how often?

Does your dog have any food allergies?

What toys and treats does your dog prefer?

What type of physical and/or mental exercise does your dog receive, and how often?

On-Leash Behavior

When on leash, my dog overreacts to the following triggers:

other dogs
people
other animals (squirrels, rabbits, birds, cats)
wind
cars
bikes

How does your dog interact or react to the triggers above when leashed?

Describe any other triggers your dog overreacts to.

Can your dog sit and take a treat around other dogs, especially when on leash?

What equipment do you use to walk your dog?

flat collar
gentle leader
harness (front clip)
harness (back clip)
choke/prong collar
standard 4 ft. leash
6 ft. leash
retractable leash

Off-Leash Behavior

When off leash, my dog overreacts to the following triggers:

other dogs
people
other animals (squirrels, rabbits, birds, cats)
wind
cars
bikes

Does your dog interact with other dogs while off leash such as at the dog park?

How does your dog behave with other dogs when off leash?

Has your dog ever bitten another dog? If yes, please describe the incident:

Reaction to People

Briefly describe how your dog reacts when people enter your home:

Is the reaction different if it's a stranger or a known person? If so, please describe.

Briefly describe how your dog reacts when you encounter people on leashed walks.

Is the reaction different if it's a stranger or a known person?

Briefly describe how your dog reacts around people when off leash.

Has your dog ever bitten, nipped or snapped at a person?

Yes
No

Did the bite or nip require medical attention?

Briefly describe the incident(s) when your dog snapped, nipped or bit a person.

Current Behavior Concerns

Please describe current behavior concerns and anything you have done to try and manage the behaviors:

Training Goals

What are your training goals?

Anything else?

Is there anything else you'd like us to know before we meet?

Name

This field is for validation purposes and should be left unchanged.