Request Form

STOP!!! --- LOOK HERE!!! --- SUPER IMPORTANT!!! --- The default "NONE" will be seen as any empty field, you must click something in the drop-down menu. If completed properly, it will take you to a Thank You Page. If you are interested in training multiple dogs, please fill out a separate form for each dog. Please fill out ALL QUESTIONS or the form will not be properly submitted.

Dog Owner's Occupation*:
Dog's Name*:
Dog's Age*:
Dog's Birthday*:

What Training or Classes are you Considering? Select all that apply*:

What Problems/Issues are you currently experiencing with you dog? Choose all that apply*:

What are your expectations?*:

Previous Training*:

Results from Previous Training*:

Do You Discipline Bad Behavior?*:

If Yes, How Do you Discipline Bad Behavior?:

Do you Reward your Dog for Good Behavior*:

How Do you Reward Good Behavior*:

Are you afraid to tell your dog what to?*:

Do You Feel Mean Telling Dog What to do?*:

How Does Your Dog Behave in the House?*:

How Does Your Dog Behave in the Car?*:

How Does Your Dog Behave in the Yard?*:

How Does Your Dog Behave at the Park?*:

How Does Your Dog Behave with Children?*:

How Does Your Dog Behave with Strangers?*:

How Does Your Dog Behave with Dogs?*:

Has your dog ever bit a person?*:

Has Your Dog Ever Been in a Fight?*:

Details on Bites/Fights:

What Does Your Dog Find Rewarding?*:

Favorite Things to Do with your Dog?*:

How sensitive are you and how well do you take constructive criticism?
1- Supersensitive, easily offended, easily embarrassed so please choose your words carefully
10-Ultra thick skin, appreciate strait forwardness, impossible to embarrass
How Sensitive are You?*:

How much are you willing to change for the sake of your dog?
1- I don't want to do anything and I'm starting to wish I got a cat
10- I will do whatever it takes because I love my dog more than life itself
How Much are you Willing to Change?*:

What kind of Exercise/Fulfillment/Games do you do with your dog and how often?*:

Please supply you vet's contact information in the field below as well as any medical conditions to be aware of. Medical Information:

Dog's Diet*:

Referred by:

Referral Name*:

Are there any additional notes you think would be useful for me to know?:

Signed Waiver*:
By clicking this box, I am indicating that I have read and consent to the rules and regulations listed in the Release of Liability Form and therefore choosing to move forward with Thriving Canine services.

If you are having problems just email me at - we'll sort it out.