WAY OF THE DOG - BRIAN LEE'S CANINE COUNSELING : (310) 543-0375 : brian@caninecounseling.com
NEW CLIENT CANINE FACT SHEET
First Name:
Last Name:
Spouse/Significant Other/Partner’s First Name:
Address:
City:
Zip:
Home Phone Number (xxx-xxx-xxxx):
Cell Phone Number (xxx-xxx-xxxx):
Work Phone Number (xxx-xxx-xxxx):
List names of others in your home(Children – please include ages, grandparents, maids, nannies, etc.):
Your email address:
Where did you hear about Brian Lee?
Dog's Name:
Breed:
Sex: Male Female Neutered Male Spayed Female
Age:
What was the dog’s age when you obtained him/her?
Where did you get the dog?
Which veterinarian or pet hospital do you use?
What physical problems, if any, does your dog have?
What medications, if any, is your dog currently on?
What brand of dog food do you use?
What type of dog food do you use? dry dry and canned canned raw
How often is the dog fed? 1 X a day 2 X a day 3 X a day 4 X a day
What is your dog’s feeding behavior fast moderate slow
Do you give your dog "table scraps?" Yes No
What is the approximate number of toys available to your dog? 1-5 6-10 11-15 16-20 21-25 26-30 31-40 over 40
Are treats given (not including chewies)? Yes No
If so, how often and why?
Where does the dog sleep at night (type of confinement, if any, and which room of the house)?
When the dog is home alone, what type of confinement, if any, is used (backyard, crate, bathroom, etc.)?
When there are people at home, is the dog in any type of confinement? If so, please describe:
What is the maximum amount of consecutive hours the dog is left alone during the day? never 1 2 3 4 5 6 7 8 9 10 11 12 more than 12
Do you have a dog door? Yes No
If so, where?
How many times a day is your dog exercised? 1 X a day 2 X a day 3 X a day 4 X a day
What type of exercise (day care, walks, dog park, etc.)?
Is the dog allowed on furniture? Yes No
Is the dog allowed on beds? Yes No
Are there other pets in your household? If so, please list name, type & age:
How do you correct your dog? (shake a can, yell, squirt bottle, etc.)
Which of the following behaviors does your dog exhibit?
Which of the following aggressive/fear based behaviors does your dog exhibit?
CANINE COUNSELING REQUIRES A 24 HOUR NOTICE PRIOR TO ANY CANCELLATION OR RESCHEDULING OF YOUR APPOINTMENT.I understand that I will be responsible for full payment of a training session for failure to cancel or reschedule my appointment within 24 hours prior to my scheduled appointment.
TERMS OF PAYMENTFull payment is either made on the first lesson or divided over the first three 1 hour lessons. Payment must be made at the beginning of the session in either check or cash. Please make checks payable to Brian Lee. If paying by credit card, payment must be made in full prior to the first lesson.
Do you agree with the above statements? Yes No
Signed (please type full name):
