Owner(s) name:
Address:
City, State: Zip code:
Home phone number: Work phone number:
E-mail address:

How many adults (18 and over) live in your house? How many children?
Who will be doing most of the handling of the dog (can be more than one person!):

What is (are) the age(s) of the persons who spend the most time with the dog?:
What other pets do you have?
How many dogs have you owned before?

Dog's name: Dog's date of birth:
Dog's breed(s):
Dog's sex: Is the dog neutered? Yes No
Is the dog shown in conformation? Yes  No
Where did you acquire your dog: Humane society Rescue group Breeder Stray Pet store Other
Please specify other:
When did you acquire this dog?

Dog's veterinarian: Date of last vaccination:
Where do you buy your dog's food?
What do you feed your dog? (Please include brand/type)

List three things you like about your dog:

What would you like to teach your dog?

How does your dog react to strangers?

How does your dog react to other dogs?

Has your dog ever bitten? No Yes
If yes, please describe the circumstance(s)?

Have you taken instruction from PAWSitive Solutions before? No Yes

If you have taken an obedience class before, which one was it, when did you take it, and what training methods/collars were used?

Where did you hear about PAWSitive Solutions: Vet's office Pet store Breeder Humane Society Newspaper Friend The Internet Other
Please specify (If someone referred me to you, I'd like to thank them; if you found me through the Internet please let me know what search engine or link led you here):

I will contact you within 48 hours to schedule an appointment to meet your dog (if you're requesting a private in-person consult), or to schedule a telephone or chat consult.  Choose your method of payment: check (at time of appointment)  credit card (for telephone or chat consults, to be paid prior to the consult)

I am interested in:

You will be sent a confirmation of your session upon scheduling.

I look forward to talking to you about your dog!

If you choose to pay by credit card, you will be asked for payment on the following page, through PayPal.  Make sure that you also submit your dog's complete history to me, prior to the session!