Good Dog! Coaching & Pet Care Training Questionnaire

Date
DATE
MM slash DD slash YYYY
Name*
NAME
First Last
Address*
ADDRESS

Street Address Address Line 2 City State ZIP Code
Email*
Cell Phone*
Day Phone*
BEST NUMBER TO REACH YOU?*
- CELL
- DAY PHONE
HOW DID YOU HEAR ABOUT US?*
SEARCH TERM, OR NAME OF FRIEND, VETERINARIAN, REFERRAL PERSON OR OTHER*
SEARCH TERM, OR NAME OF FRIEND, VETERINARIAN, REFERRAL PERSON OR OTHER
WHY DID YOU CHOOSE GOOD DOG! COACHING?*
WHY DID YOU CHOOSE GOOD DOG! COACHING?
List ALL Dogs living in your home. Click + button for additional dogs after the first*
ANIMAL'S NAME AGE & WEIGHT BREED OR MIX MALE OR FEMALE SPAYED OR NEUTERED
HOW LONG HAVE YOU OWNED THE DOG(S)?*
DOG #1 DOG #2 DOG #3 DOG #4
WHAT VET CLINIC DO YOU USE?*
NAME OF CLINIC CITY PHONE
Does your dog(s) have any medical conditons/ any prescriptions, or is your dog(s) on a restricted diet?*
- YES
- NO
If yes, please elaborate.
IF YES, PLEASE ELABORATE.
When was your last vet visit?*
WHEN WAS YOUR LAST VET VISIT?
Reason for vet visit?*
REASON FOR VET VISIT?
May we consult with your vet?*
- YES
- NO
Is your dog microchipped?*
- YES
- NO
Does your vet ever muzzle your dog(s) for routine procedures? Please check all that apply*
- Dog #1
- Dog #2
- Dog #3
- None of the above
What type of collar does your dog(s) normally wear?*
- Buckle/Clip
- Choke/Slip
- Pinch/Prong
- Other
If "Other" Please explain
Why did you get your dog(s)? Please check all that apply*
- Companionship
- Protection
- Therapy
- For Child/children
- For Breeding
- Working Dog
- For Spouse
- As a gift
- For Competition/Show
- To Perform Service Tasks
- Other
If "Other" Please explain
Why did you choose this breed/type of dog?*
Have you owned other dogs in the past?*
- YES
- NO
What breeds have you owned before?
HAS ANY PROFESSIONAL MEDICAL TREATMENT BEEN NECESSARY FOR PEOPLE AS A RESULT OF ANIMAL AGRESSION?*
- YES
- NO
IF YES, PLEASE EXPLAIN THE EXTENT OF INJURIES AND TREATMENT.
HAS ANY PROFESSIONAL MEDICAL TREATMENT BEEN NECESSARY FOR PETS AS A RESULT OF ANIMAL AGGRESSION?*
- YES
- NO
IF YES, PLEASE EXPLAIN THE EXTENT OF INJURIES AND TREATMENT.
Have any legal authorities ever been contacted as a result of aggression?*
- YES
- NO
Has your dog ever threatened (growl, snarl, snap, bite) any person?*
- YES
- NO
Has your dog ever threatened (growl, snarl, snap, bite) any companion animal?*
- YES
- NO
Has your dog ever injured any person?*
- YES
- NO
Has your dog ever injured any companion animal?*
- YES
- NO
Has your dog ever delivered multiple bites, scratches during one incident?*
- YES
- NO
Has your dog ever delivered one or more deep puncture wounds or bites with tearing motion?*
- YES
- NO
Have you or anyone else tried to correct the aggression?*
- YES
- NO
- DOES NOT APPLY TO MY DOG
Have you considered re-homing your dog?*
- YES
- NO
Have you considered euthanasia?*
- YES
- NO
Do any caregivers (vet, groomer, etc) sedate or restrain your dog for routine care?*
- YES
- NO
IF YOU ANSWERED YES TO ANY OF THE PREVIOUS QUESTIONS, PLEASE STATE WHEN AND ELABORATE WITH SPECIFIC DETAILS. YOUR INPUT IS EXTREMELY IMPORTANT!!!
IF YOUR DOG HAS HAD ANY BITE, NIPPING INCIDENTS PLEASE STATE WHEN AND ELABORATE WITH SPECIFIC DETAILS. YOUR INPUT IS EXTREMELY IMPORTANT!!!
Does your dog know any commands or tricks?*
- YES
- NO
Which commands or tricks?
Check all methods used to train your dog.*
- Food Rewards
- Non-food Rewards
- Corrections
- Clicker
- None
Check all training aids or tools used with your dog.*
- Head Halter
- Body Halter
- Martingale Collar
- Slip Leash or Choke Chain
- Pinch or Prong Collar
- Remote or E Collar
- Invisible Fence or Interior Electronic Containment System
- Bark Collar
- Clicker
- Target
- None of the above
Is your dog reliably house trained?*
- YES
- NO
Have you ever used potty or pee pads to house train your dog?*
- YES
- NO
Are you currently using potty or pee pads to house train your dog?*
- YES
- NO
Is your dog crate trained? Comfortable in the crate? Yes or No and give details.
Is your inside dog ever confined when you are home?*
- YES
- NO
If yes, where and why?
Where does your dog stay when you are away at work?*
Where does your dog sleep?*
How much time is your dog alone each day?*
How much alone time outside?*
Tell us about your dog's outside area*
- Conventional Fence
- Invisible Fence
- Combination
- Outside Kennel
- Patio
- Field
- Other
- No outside area
How much time do you spend playing/training/interacting with your dog(s) each day?*
Do you take your pet on outings or walks?*
- YES
- NO
If no, is it because of your dog's behavior?*
- YES
- NO
Please explain any problems during outings or walks. Nervousness, Reactive, Aggressive, Over Excited.
If yes for outings or walks, how often? daily-weekly monthly?
How long are most outings or walks?*
- 15 minutes
- 30 minutes
- 45 minutes
- 60 or more outings
- I don't take my dog on outings
- I don't take my dog for walks
What type of collar / harness do you use during walks?*
What type of leash / lead do you use during walks?*
What are your dog's favorite toys / games?*
What brand /type (wet/dry/combo) of food are you currently feeding your dog? PLEASE BE DETAILED.*
Why did you choose this product?*
How often does your dog eat each day?*
- 1 time a day
- 2 times a day
- 3 times a day
- 4 times a day
- Free feed/bowl always contains food
Has your dog gained weight in the past three months?*
- YES
- NO
Has your dog's coat changed in the past three months?*
- YES
- NO
What negative behaviors are you experiencing?*
- Jumping up on people
- Jumping up on furniture
- Excessive barking
- Excessive chewing
- Excessive digging
- Excessive licking
- Reactive(growling, lunging, barking, spinning) towards people while on leash
- Reactive(growling, lunging, barking, spinning) towards dogs while on leash
- Reactive(growling, lunging, barking, spinning) towards people while off leash
- Reactive(growling, lunging, barking, spinning) towards dogs while off leash
- Pulling on leash
- Separation anxiety
- Toileting in the house
- Submissive urination (pees when excited or scared)
- Mouthing (puppy play biting)
- Overexcited behavior
- Counter surfing
- Demanding attention
- Resource guarding/aggression (guarding of toys or food)
- Other
- None of the above
If "Other" Please Explain
SPECIFIC GOALS HERE
Please tell us your specific expectations and goals for our training sessions together. What would you like to learn? What changes in your dog would you like to see? BE VERY SPECIFIC!
Please list the names, ages & gender of people in the household. Also list any animals, their species, age, name and gender not listed earlier.*
AGREEMENT and RELEASE - PLEASE CHECK THE SERVICE YOU DESIRE
GOOD DOG! SUPER DOG-$960-8 HOURS in 5 IN-HOME SESSIONS (SAVINGS of $200!)
- 8 hours of private in-home instruction during 5 visits. Includes: 2 Double Sessions (2 hours each) 2 Regular+Half Sessions (90 minutes each) and 1 Regular Session (1 hour)- to be conducted within 90 days of the Initial Session. Also includes 1 year Free of Good Dog! Remote Support.
GOOD DOG! RISING STAR-$780-6 HOURS in 4 IN-HOME SESSIONS (SAVINGS of $90!)
- 6 hours of private instruction during 4 visits. Includes: 2 Double Sessions(2 hours each) and 2 Regular Sessions(1 hour each)-to be conducted within 90 days of Initial Session. Also includes 1 year Free of Good Dog! Remote Support.
GOOD DOG! BACK TO BASICS-$540-4 HOURS in 3 IN-HOME SESSIONS (SAVINGS of $40!)
- 4 Hours of private instruction during 3 visits. Includes 1 Double Session (2 hours) and 2 Regular Sessions(1 hour each)-to be conducted within 60 days of the initial session.
GOOD DOG! JUMP START-$411-3 Hours in 2 IN-HOME SESSIONS (SAVINGS of $24!)
- 3 Hours of private instruction during 2 visits. Includes 1 double session (2 hours) and 1 Regular session (1 hour)-to be conducted within 60 days of the initial session.
Double Session-$280-2 HOURS in 1 IN-HOME SESSION ($10!)
- 2 Hours of private instruction during 1 visit.
Regular Session-$145-1 HOUR IN-HOME CONSULT
- 1 hour private in-home consultation.
GOOD DOG! COACHING REMOTE SUPPORT
- Email / Telephone Consultation & Support. 10 minutes a month is free for anyone (clients & non-clients), then $60 for 30 minutes. Clients who purchase our Super Dog or Rising Star Program receive 1 year unlimited Remote Support!
TERMS AND CONDITIONS
Payment is due in full at the end of the first training session. Accepted forms of payment are Cash, Check or Credit/Debit Card. When paying by credit card a small convenience fee will be added. For clients outside our normal 10 mile travel radius (we are in Lilburn) a trip charge per visit will be added to your chosen program. Up to 20 miles $20 per trip, 21- 30 miles is $35 per trip , 31-40 miles $45 per trip, 41-50 miles $60 per trip.*
- By checking this box I agree to the above conditions.
The terms and conditions of this agreement may not be changed orally. Any deviation from this agreement does not alter the remaining portions. This agreement is not transferable. This agreement is between Good Dog! Coaching (including all agents, representatives, or associated parties) (RELEASEE) and the above "Client" (RELEASOR). The Sessions(s) included with the Good Dog! Full Training Program and the Good Dog! Super Dog! shall be completed with in 90 days of the starting session. The Good Dog! Back to Basics and Good Dog! Jump Start Programs shall be completed with in 60 days of the starting session. All Unused Sessions are forfeited at the end of the 60 day period. No Refunds of any kind for unused sessions after the completion of the first session. Clients that contact us to reschedule appointments within 24 hours of a scheduled appointment will be charged a rescheduling fee of $100.*
- By checking this box I agree to the above conditions.
Clients that contact us to cancel or reschedule appointments within 24 hours of a scheduled appointment will be charged a rescheduling fee of $100. A No show to a scheduled appointment will result in forfeiture of that session*
- By checking this box I agree to the above conditions.
Good Dog! Coaching agrees to instruct the "Client" in Good Dog! Coaching philosophies and preferred method of training for the amount of time allocated to the session. Client agrees that Good Dog! Coaching is in no way responsible for the behavior of the animal during, or following, all sessions. Good Dog! Coaching does not guarantee specific results, as results are largely dependent on owner/handler compliance and consistency. We do guarantee to provide the services as described in this contract. Client agrees to control normal household distractions such as television, telephone interruptions, children or foot traffic, or to provide a quiet distraction-free area for the sessions at per Good Dog! Coaching representative's requests.*
- By checking this box I agree to the above conditions.
If at any time during the Course Period Good Dog! Coaching representative feels the animal is ill, abused, or exhibiting any behaviors that interfere with teaching methods or endanger the health and safety of any participants or bystanders, including the animal, OR Good Dog! Coaching representative feels the "Client" has motives, goals, or demands that are not in concert with Good Dog! Coaching Code of Ethical Conduct, our representative may abort the session, alter the service selection, and/or alter the length of the Course Period.*
- By checking this box I agree to the above conditions.
By Checking below, I understand that every animal reacts in a different manner to training and that animals are by nature unpredictable. Therefore training requires full attention and total awareness at all times. Animals may, without warning cause injury to humans and/or other animals and I, the undersigned as RELEASOR, in consideration of Good Dog! Coaching as RELEASEE, release and indemnify RELEASEE's, owners, heirs, executors, administrators, successors, employees, agents, directors, officers, and anyone acting in the scope of business as a representative of Good Dog! Coaching as to attacks, bites, scrapes, scratches, mauling, or all of them, by animals, to any persons or animals including my own, before, during and after any sessions with Good Dog! Coaching personnel. I hereby release Good Dog! Coaching and each event site's property owner from any and all liabilities to either my dog or myself, associated with my participation in the above described activities. Furthermore Good Dog! Coaching will not be responsible or libel for any damages due to the uncontrolled behavior of any animal or negligence on the part of the dog's owner/handler before, during or after training. I have read and fully understand these guidelines. My participation in this activity is at my own risk, and I do so freely. This contract may not be changed orally.*
- By checking this box I agree to the above conditions.
SIGNATURE*

*BY TYPING YOUR NAME ABOVE YOU AGREE THAT THIS IS VALID AS YOUR SIGNATURE.
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Good Dog! Coaching & Pet Care Training Questionnaire

AGREEMENT and RELEASE - PLEASE CHECK THE SERVICE YOU DESIRE

TERMS AND CONDITIONS

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ANIMAL'S NAME	AGE & WEIGHT	BREED OR MIX	MALE OR FEMALE	SPAYED OR NEUTERED

DOG #1	DOG #2	DOG #3	DOG #4

NAME OF CLINIC	CITY	PHONE

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Good Dog! Coaching & Pet Care Training Questionnaire

AGREEMENT and RELEASE - PLEASE CHECK THE SERVICE YOU DESIRE

TERMS AND CONDITIONS

Have More Questions? Ready To Reserve? Contact Us Today!

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Let’s Socialize

CAREER OPPORTUNITIES

Fully Bonded & Insured!