City Dog Training, LLC

PLEASE NOTE – DUE TO A BUSY WORK AND TRAVEL SCHEDULE, I AM UNABLE TO TAKE NEW CLIENTS AT THIS TIME.

This questionnaire is for people wishing to schedule a private consult with Marjie and City Dog Training. I am not giving any classes at this time.

If you wish to register for a dog training class go to Magicalmutt.com.

Questionnaire must be completed before our first appointment!
Your first appointment will generally lasts two hours and costs $250. After that, we meet as little or as often as you find helpful, at the hourly rate of $125. 1 month of e-mail follow-up, take-home work, hand outs, video links and other needed information are included in the initial consult appointment fee.

Please be as thorough as possible when completing the questionnaire below, include every detail you think might help me understand your dog’s situation and might enable me to better help you and your dog.

Behavior Questionnaire

1. First Name(required)
2. Last Name(required)
3. Email(valid email required)
4. Home Phone(required)
5. Cell Phone(required)
6. Address(required)
7. Town/City(required)
8. Number of people living in the house, their names and ages(required)
9. What is your dog's name?(required)
10. Is the dog male or female?
11. Male Female
12. Intact, Spayed or Neutered?
13. Intact Spayed/Neutered
14. Breed or Mix(required)
15. Weight(required)
16. Age of dog now(required)
17. Age of dog when obtained(required)
18. Where did you get your dog?(required)
19. How may we help you? What are you hoping to accomplish with your training? Please be specific with the issues.(required)
20. How long has your dog had this issue/these issues?(required)
21. Have these issues gotten better, worse or stayed the same in the last year?(required)
22. Other dogs in the household, names, breeds and mixes, how long have they lived with you:N/A
23. In what order did they join the family?(required)
24. Any other pets? Please list:N/A(required)
25. Vet's name:(required)
26. Does the dog have any health issues now? Please describe.N/A(required)
27. Any health issues in the past? Please describe.N/A(required)
28. Please list any medications your dog is on:(required)
29. What do you feed your dog?(required)
30. Is this your first time owning a dog as an adult?
31. Yes No
32. Does your dog use a crate regularly?
33. Yes No
34. Where is your dog when left alone in the house?(required)
35. How often is your dog left alone in the house?(required)
36. For how long is he left alone on average?(required)
37. How does your dog react to being left alone?(required)
38. Have you ever taken your dog to an obedience class?
39. Yes No
40. If so, where and with whom?N/A(required)
41. What skills does your dog know? (Sit, down, stay, shake etc.)(required)
42. Does your dog chew destructively when you're home?
43. Yes No
44. Does your dog chew destructively when you're not home?
45. Yes No
46. How much exercise does your dog get each day?(required)
47. What kind of exercise?(required)
48. Is your dog afraid of storms, noises, flooring, or any other environmental thing in particular? Please specify:(required)
49. If you go near or touch your dog's food or dish when he is eating, will he bite, show teeth, snap, growl or "freeze" in place?
50. Yes No
51. If your dog has a treasured object (toy, ball, stick, chew bone, treat) in his mouth and you try to take it from him, will he bite, show teeth, snap, growl or "freeze" in place?
52. Yes No
53. If your dog is on your bed or the furniture and you ask him to move or get off, will he bite, show teeth, snap, growl or "freeze" in place?
54. Yes No
55. What is his typical reaction when meeting or seeing dogs?(required)
56. Is his reaction the same on-leash and off-leash? If not, how is it different?(required)
57. Have you ever been concerned about your dog's interaction with family members?
58. Yes No
59. If so, why? Please be specific:N/A(required)
60. Have you ever been concerned about your dog's interaction with non-family members?
61. Yes No
62. If so, why? Please be specific:N/A(required)
63. How many times has your dog bitten another dog?(required)
64. Please describe in detail the last two times your dog bit or was in a fight with another dog and the level of injury to the dogs. Please include the most severe level of injury your dog has caused, even if it didn’t occur during the last two incidents.N/A(required)
65. How many times has your dog bitten a person?(required)
66. Please describe in detail the last two times your dog bit someone, and the level of injury to the person. Please include the most severe level of injury your dog has caused, even if it didn’t occur during the last two incidents.N/A(required)
67. Please list three things you love about your dog:(required)
68. How did you hear about City Dog Training?(required)
69. I have read and, by completing this form, agree to abide by the Waiver, Assumption of Risk and Agreement to Hold Harmless, and the Guidelines of City Dog Training, LLC.

 

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I understand that dog training and behavior modification, work in classes or events is not without risk to myself, members of my family, guests, or my dog or other pets. I hereby waive my rights to any claim and release City Dog Training,LLC it’s instructors and agents from any and all liability of any nature, for injury or damage which I or my dog may suffer, including specifically, but not limited to, any injury or damage resulting from the action of any dog, and I expressly assume the risk of any such damage or injury while attending any playgroup training session, function or event wherever the activity is taking place. In consideration of and as inducement towards the acceptance of my enrollment in lessons, I hereby agree to indemnify and hold harmless City Dog Training, LLC, its instructors and/or agents from any and all claims, or claims by me, any member of my family or any other person accompanying me to any training session wherever they may be located arising out of any action by any dog, including my own, including but not limited to the responsibility for all damages, expenses and legal fees. I further indemnify and agree to hold harmless City Dog Training, LLC, the instructors and/or agents from any and all claims, or claims by any third party at any training session wherever they may be located arising out of any action by any dog, including my own, including but not limited to the responsibility for damages, expenses and legal fees. I have read and, by completing this form, agree to abide by the aforementioned Waiver, Assumption of Risk and Agreement to Hold Harmless, and the Guidelines of City Dog Training, LLC.