Client Profile

Name:*

First NameLast Name

Address:*

Street Address

Street Address Line 2

CityState

Zip Code

Email:*

Confirmation Email

Main Phone Number:*

Area CodePhone Number

HomeCellWorkOther

Alternate Phone Number:

Area CodePhone Number

HomeCellWorkOther

What is your preference as to how I contact you? Phone or Email. If by phone, what would the best days/times to reach you?*

How did you find me? If a referral, may I thank that person?*

What type of home do you have? (House, condo, apartment, etc) *

Do you have a private yard? How large? How is your dog contained in the yard?*

How many adults in the household (including you)? Children...ages/gender?*

Do you, or any other household members, have any physical limitations of which you would like me to be aware?*

Any other pets in the home? What kind, (cats, dogs, rabbits, gerbils…), age, gender and if neutered or spayed?*

Have you taken a dog training class previously? If so, please describe methods used.*

Dog's Name:*

Breed:*

Gender:*

Age when acquired:*

Current Age:*

Where did you acquire your dog? (Breeder, Shelter, Pet Store…)*

Who is your primary Veterinarian (Clinic Name and specific doctor if you wish)?*

Address and Phone of your Veterinarian:*

Date of last visit:*

Is your dog on any medication? If so, specifically what medication and why?*

Any health concerns about your dog? If so, what are they?*

What do you feed your dog? (Brand name, kibble, canned, raw, homemade)*

How often is your dog fed and at what times?*

How much is your dog fed per meal?*

Who feeds your dog? *

Where does your dog get his/her meals?*

How is your dog’s appetite?*

How is your dog’s stools and urine?*

Any potty accidents in the home? If so, how often? What happens when there is an accident?*

Do you give treats to your dog? If so, what type and how often?*

Does your dog have any food allergies or sensitivities? If so, please be specific.*

Does your dog have any physical limitations?*

Describe your dog’s relationship with other pets in the house:*

What equipment have you used with/on your dog:*

Any other equipment not listed?*

How much time per day on average does your dog spend outdoors? *

How long each day is your dog left home alone?*

When left alone, is your dog in a crate, restricted to an area or room, or have free range of the home?*

Where does your dog sleep?*

How does your dog get physical exercise? How often and how long each time? On leash and off leash?*

How does your dog get mental exercise? How often and how long?*

Does your dog go to Doggy Day Care? If so, where?*

What methods do you use when interacting with your dog (check appropriate box)?*

	Often	Occasionally	Rarely	Never
Treats or toys to reward your dog
Praise or petting to reward your dog
Verbal punishment for unwanted behavior
Physical punishment for unwanted behavior
Time Outs or crating for unwanted behavior
Cues/signals to ask for behaviors
Lures/targets to teach behaviors
Physical positioning to gain behaviors
Talk to your dog
Rough play (wrestle for example) with your dog
Reassurance when your dog is nervous

How does your dog react when meeting new people? Does your dog react differently if meeting in your home, or in public? On leash, or off leash?*

How does your dog react when meeting/seeing other dogs? *

What three things do you love about your dog?*

What three (or more) things can your dog do really well: (sit, down, stay, come, tricks, leave-it, etc)*

Describe your dog’s personality:*

Is your dog fearful of anything (fireworks, thunderstorms, children, crowds for example)? If so, what is your dog doing that tells you he/she is frightened?*

Is your dog shy or timid? If so, what are your observations when he/she is shy/timid?*

What would you change about your dog if you could?*

Please describe, in detail, what goals you have for your dog? These may be training goals, or behavior change goals. Use as much space as needed, so I can completely understand how I can help.*

Of those goals, what three are the most important? *

If you are looking for behavior changes (as opposed to training), when did the behaviors begin? *

How often and where do you see these behaviors? (# of times per day, specific time(s) per day, locations where you see occurrences)*

What have you done to try to help improve these behaviors? (type of discipline, management measures, confinement, training, etc)*

How did your dog respond to these measures?*

Has your dog ever bitten a person? Describe the situation(s) that led up to the bite(s):*

How much damage was inflicted with each bite (skin broken, punctures), and was medical treatment sought afterwards?*

What else do you want me know? Be as detailed as you like, the more I know, the more I can help!

Client's Assumption of Risk: Client acknowledges that Training Premises, and the animals, guests, items and activities thereon, pose dangers to people and animals. Such dangers include, by way of example and not limitation, animals that can bite, trip, knock down, and fight, indoor and outdoor surfaces that may be slippery, equipment that can trip, guests and clients who cannot control their dogs, and activities involving Dog and/or other dogs that can result in injury from bites or other causes. Accordingly, Client, on behalf of him/her, his/her spouse and minor children, and anyone else whom Client brings onto Training Premises, assumes the risk of injuries, losses, damages, costs and expenses by any means above described, and other injuries, losses, damages, costs and expenses of every possible cause and description unless inflicted intentionally or recklessly by the agents and employees of Dog Lady, LLC. If Dog is injured in a dog fight or an accident, gets fleas, ticks or worms, contracts any illness or disease, is lost or stolen, becomes pregnant, or engages in any dangerous, vicious or unwanted behavior, during or after the term of this Agreement, on or off Training Premises, Client accepts the risk of the same and agrees that Dog Lady, LLC shall not be held responsible for it or any resulting injuries, losses, damages, costs or expenses.

Client's Liability: If Dog causes property damage, or bites or injures any dog, animal or person (including but not limited to Dog Lady, LLC and her agents and employees), during or after the term of this Agreement, on or off Training Premises, then Client agrees to pay all resulting losses and damages suffered or incurred by Dog Lady, LLC and her agents and employees, and to defend and indemnify Dog Lady, LLC and her agents and employees from any resulting claims, demands, lawsuits, losses, costs or expenses, including attorney’s fees.

Client agrees to cause anyone that he brings onto Training Premises (including Client's spouse, adult friends, and the parents of nonrelated children) to execute a copy of the Waiver and Release for Entry to Premises which will be made available by Dog Lady, LLC; as a remedy if Client breaches the foregoing provision, Client will defend and indemnify Dog Lady, LLC and her agents and employees against any claims, demands, lawsuits, losses, costs or expenses, including attorney’s fees, brought by or on behalf of any such persons.

Termination: At Dog Lady, LLC's sole election, Dog Lady, LLC's duties hereunder shall terminate if (a) in Dog Lady, LLC's sole judgment Dog is dangerous or vicious to Dog Lady, LLC or any other person or animal, or interferes with the training of other dogs, or (b) Client breaches any term or condition of this Agreement. Upon termination in accordance with the foregoing, Dog Lady, LLC's duties shall terminate but all other provisions of this Agreement shall continue in full force and effect.

Legal Provisions: This Agreement is binding upon Client, the spouse of Client, and the children of Client. This Agreement supersedes all prior discussions, representations, warranties and agreements of the parties, and expresses the entire agreement between Client and Dog Lady, LLC regarding the matters described above. The parties confirm that, except for that which is specifically written in this Agreement, no promises, representations or oral understandings have been made with regard to Dog or anything else. Without limiting the generality of the foregoing, Client acknowledges that Dog Lady, LLC has not represented, promised, guaranteed or warranted that Dog can be trained, that Dog will never bite, that Dog will not be dangerous or vicious in the future, that Dog will not exhibit other behavioral problems, or that the training will last for any particular amount of time. This Agreement may be amended only by a written instrument signed by both Client and Dog Lady, LLC. Any remedy provided in this Agreement is in addition to any and all other remedies provided by law or equity. If any provision of this Agreement is invalid, void or unenforceable, they will be severed and the remaining provisions shall be given full force and effect.

Digital Media: I consent to the use of photographs and video of Dog by Dog Lady, LLC, including posting to Dog Lady, LLC’s web site, Facebook or YouTube or in email messages.

As a Certified Professional Dog Trainer-Knowledge Assessed I cannot promise results, and an ethical dog professional would never promise or guarantee results. As a member of the Association of Pet Dog Trainers and Force Free Trainers of Wisconsin I agree with their Code of Ethics. Dogs vary in learning ability. Some dogs learn things with fewer or greater repetitions, while other skills are easier or harder to learn. Therefore, one cannot predict or guarantee performance or results. Training and socialization should be considered an ongoing process throughout the lifetime of the dog. I also offer behavior modification, which is the process of changing a dog's emotional response to stimuli. To do so, I use only standard methods of classical and operant conditioning in an effort to overcome (already) learned behaviors such as fears.

Please check the box below if you have read and agree to the terms listed above.*

Yes, I agree.

I would like to receive emails about upcoming Dog Lady events and classes

Yes pleaseNo thank you

Client Profile

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About Your Dog...