Behavior Questionnaire

Adult Dog Coaching Form

I do NOT service some areas such as Satsuma, Saraland, Baldwin County, Dauphin Island, Downtown/Midtown, Wilmer, Chickasaw, or Eight Mile. If you are unsure I service your area, email to verify before filling out a form to mobiledogconsulting@gmail.com
Please submit a separate form for EACH dog who needs training. Dogs in the same household do not incur additional training fees unless there are vastly different training goals to address with each dog.
This form is for basic/advanced/manners training only. If you need help with serious behavior problem-solving such as aggression, fighting, fearfulness, severe anxiety, etc please email us with a brief description of the issues you are having and your location to mobiledogconsulting@gmail.com.*

I understand this form is NOT for serious behavior problems
Full Name*

First NameLast Name
Phone Number*
Do you receive texts to this number?*

YesNo
E-mail*
What is the best way to contact you?*

Phone callEmailTextFacebook Messenger
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about me?*
Tell me about your dog:
Dog's Name*
Breed or mix*
Where did you get your dog?*

Rescue Group/Adoption eventFriend/neighbor/family memberCity/County ShelterBreederFound/strayPet Store/Flea MarketOther
Please include NAME of rescue, shelter or breeder if applicable.
Why did you obtain this dog?*

Companionship/wanted a petReceived as a giftDog sports/performance/competition (disc, agility, scentwork, etc)Conformation showingPersonal protection, watchdogWorking dog (herding, livestock guardian, service animal, hunting, etc)Therapy workCompanion/playmate for other dog/pet/child/spouseNo reason, wasn't plannedOther
Dog's age:*
How long have you owned your dog?*
If you got your dog as a puppy, how old was s/he when you brought him/her home?*
Is your dog spayed or neutered?*

YesNoNot Yet
Dog's sex:*

MaleFemale
Dog's weight*
Coat color:*
Do you use a crate with this dog?*

YesNoWe have one but do not use it.
Has your dog ever bitten a person?*

YesNo
Did the injury require medical treatment?

YesNo
Describe the severity of the injuries inflicted:
Please explain the circumstances of the bite/s:
Is your dog motivated by food/treats?*

YesSometimes/Depends on the food/treatNo
Is your dog motivated by toys?*

YesSometimes/Depends on the toyNo
How do you exercise your dog? (check all that apply):*

Long walks, sniffaris (30+ minutes at least 4x a week)Short walks (less than 30 minutes at least 4x a week)Fetch, flirt pole, tug, etc (high exertion activity)Jogging, running, treadmill, bikejoring, etcFree play in yard, play with other dog in householdDogparkSwimming (at least once a week)Light play indoors and/or in yardStructured training & body conditioning exercises
What equipment do you use to walk your dog?*

Regular, buckle collarMartingale/Limited slip collarChoke chainProng/pinch collarHarness (regular or no-pull)Head harness (Halti, Gentle Leader, etc)Other
Do you walk your dog using a Flexi/retractable leash?*

YesNoSometimes
Has your dog EVER worn an electronic/shock collar?*

NoYes, for training with meYes, for training with a trainerVibration onlyInvisible/Underground fence onlyI'm not sureOther
Do you CURRENTLY use an electronic/shock collar?*

NoYes, for training with meYes, for training with a trainerVibration onlyInvisible/Underground fence onlyOther
List any medications with dosage/s (including preventatives) your dog is currently on:*
Does your dog have allergies? (please list what they are allergic to, if known)*
Does your dog have diet restrictions? If yes, list problem foods:*
What brand/s of dog food do you feed your dog?*
How many times a day is your dog fed?*
Additional Information
Veterinarian (Vet's name & clinic name):*
Is your dog current on rabies vaccination/titered within the last 3 years?

YesNoI don't knowMy dog will be vaccinated soon
Has your dog had any training?

None/Some at homePet Store classes/private lesson/s in storeProfessional trainer (private lessons or group class/es)Sent to Board & TrainOther
List any skills your dog has been taught (sit, down, stay, etc):*
Does your dog (check all that apply):

jump on peoplepull on leashbolt out of doorsgrowl or bark at visitorsguard foodguard toysbark too muchignore you when you call him/hermouth/bite/chew hands or clothingdig in the yardchew/destroy things such as shoes, household itemsshow fear and/or anxietyguard certain people or spacesescape the yardcounter surffight with other dogs in the homeshow any type or level of human aggressiondislike handling/pettinguse the bathroom inside
Please tell me what we can help you with? Why are you reaching out for training help?*
Please be specific about any issues you are having and/or things you'd like to teach your dog.
How long have you been dealing with the issue/s?*
What/how have you tried to fix the issues?*
Have there been any major changes recently? (move, pet or person passed away, diet change, etc)*
Please list any other pets in the home (name, breed, age):
Names of other adults living in the home:*
Age/s of children who live in the home:*
Where does your dog sleep at night?*

Crate/Kennel indoorsIn a room with door closed or baby gateLoose in home (free range)In bed with a personOutsideOther
How much time does your dog spend home alone?*

Never, someone is always with my dogMinimal, brief periods of time occasionallyA few hours at a time (up to 4 hours)Several hours at a time (longer than 4 hours)All day/workday (8+ hours solid regularly)Other
Where does your dog stay when home alone?*

Crate/Kennel indoorsOutsideIn a room with door closed or baby gateLoose in home (free range)Other
How does your dog/s respond to people they do not know coming into the home? ex: very friendly, afraid, aggressive, barks but then is friendly, etc)*
Is there anything else you would like us to know about you or your dog/s?*
I am interested in:*

Basics Program (3 sessions) $350Manners Program (5 sessions) $550Prodigy (8 sessions) $850I need help deciding
Program sessions expire 3 months from date of first session. No exceptions:*

I agree
I understand there is a $150 non-refundable deposit required to book a consultation (payable via Venmo, Cash App, or Zelle) & balance of program is due at consult. We do not accept cash or checks for consult deposit, no exceptions:*

I agree
What days/time frames would be best for you to schedule a 1.5 hour consult?*
Should be Empty:

Adult Dog Coaching Form

Tell me about your dog:

Additional Information