Request Form

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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.

First Name*
Last Name*
Dog Owner's Occupation*:
Dog's Name*:
Breed*:
Dog's Age*:
Dog's Birthday*:
Sex*:--None--Female in Tact Female Spayed Male In Tact Male Neutered

What Training or Classes are you Considering? Select all that apply*:In-Home Private Training Puppy Socialization/Obedience Class Basic Obedience Class Advanced Obedience (Drop-In Class) Non-Competitive Agility Walk n Train Board n Train

What Problems/Issues are you currently experiencing with you dog? Choose all that apply*:Aggression Barking Chewing Digging Fearful/Shy Getting on Furniture Housebreaking Jumping Mouthing/Nipping Other Separation Anxiety Unruly in House

What are your expectations?*:

Previous Training*:--None--Yes- A Lot Yes- Some Yes- Very Little No

Results from Previous Training*:

Do You Discipline Bad Behavior?*:--None--Yes No

If Yes, How Do you Discipline Bad Behavior?:

Do you Reward your Dog for Good Behavior*:--None--Yes No

How Do you Reward Good Behavior*:

Are you afraid to tell your dog what to?*:--None--Yes No

Do You Feel Mean Telling Dog What to do?*:--None--Yes No

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?*:--None--Yes No

Has Your Dog Ever Been in a Fight?*:--None--Yes No

Details on Bites/Fights:

What Does Your Dog Find Rewarding?*:
Affection Fetch Other Play Ball Swimming Toys Treats Tug of War Walks/Hikes/Running

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?*:--None--1 2 3 4 5 6 7 8 9 10

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?*:--None--1 2 3 4 5 6 7 8 9 10

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:--None--Internet Search Friend or Relative Veterinarian Festival Booth Thriving Canine Radio Yelp Facebook/Twitter Other Other Canine Professional YouTube

Referral Name*:

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

Street*
City*
State/Province*
Zip*
Phone* -(please fill out phone number. we don't share it with anyone.)
Email*
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 Chad@ThrivingCanine.com - we'll sort it out.