Behaviour Modification Form

Name *

First

Last

Address *

City *

Province *

Postal Code *

Phone Number *

Email *

Your Dog's Name *

Breed or Mix *

Coat Colour(s) *

Gender *

Age *

Weight *

Sterilization *

Neutered
Spayed
Intact

How did you hear about mutt & moggy Training & Pet Care? *

We value referrals! If you were referred to us, please let us know so that we can thank them!

Who is your dog's veterinarian? *

When was your dog's last physical examination at the veterinarian? *

Does your dog have any known medical issues? *

Yes
No

If YES, what are your dog's known medical issues?

Please list all medications and dosages that your dog is currently on.

Vaccination Status *

My dog is up to date on all core vaccines.
My dog has a positive titre test not older than one year.
My dog is up to date on the rabies vaccine.

Where did you obtain your dog? Please include the name of the rescue, shelter, or breeder, if applicable. *

Why did you obtain your dog (companionship, guard dog, sport competition, playmate for current dog, etc.)? *

When did you obtain your dog? *

If you obtained your dog as a puppy, how old was s/he when you brought her/him home? *

Has your dog had any prior training? *

Who was the trainer? *

Is your dog crate trained? *

What training tools do you currently use with your dog? Check all that apply. *

Other training tool - please list.

Do you walk your dog using a Flexi or retractable leash? *

Yes
Sometimes
No

Does your dog receive daily walks of at least 45 minutes per day? *

Yes
No

If your dog has food allergies, please list them here (or input n/a). *

What brand(s) of food do you feed your dog? *

Feeding schedule? *

Free fed (food always available)
Scheduled mealtimes (eats everything)
Scheduled mealtimes (grazes)

Food drive? *

Toy drive (playing fetch or tug with people)? *

What behaviours are you looking for help with? *

If your dog's behaviour is not listed above, please describe it here in detail.

How long have you been dealing with the issue(s)? *

What behaviour modification have you done to date, if any?

Is your dog friendly with unfamiliar people? *

Seems to love just about everyone
Good with unfamiliar women
Good with unfamiliar men
Good with unfamiliar children
Selective with all people
Tolerant (okay in their presence, but doesn't like to be touched by strangers)
Scared, avoids strangers
Aggressive (growls, barks, lunges, etc.)
Not sure

Is your dog friendly with unfamiliar dogs? *

Has your dog ever bitten a person (not including puppy nipping or play mouthing)? *

If YES, please describe the injuries inflicted in detail and explain the circumstances of the bite(s).

Is there anything else you would like us to know?

What days / time frames would work best for you to schedule a behaviour modification initial consult? *