New Client Form

1Your basic information

Your email address: Spouse/Significant Other/Partner's First Name: Address:

List names of others in your home
(Children - please include ages, grandparents, maids, nannies, etc.) Where did you hear about Brian Lee?

2About Your Dog

What was the dog's age when you obtained him/her? Where did you get the dog? Which veterinarian or pet hospital do you use? What physical problems, if any, does your dog have? What medications, if any, is your dog currently on?

Do you give your dog "table scraps?" Yes No What is the approximate number of toys available to your dog? 1-5 6-10 11-15 16-20 21-25 26-30 31-40 over 40 Are treats given (not including chewies)? Yes No If so, how often and why? Where does the dog sleep at night? When the dog is home alone, what type of confinement, if any, is used? When there are people at home, is the dog in any type of confinement? If so, please describe: What is the maximum amount of consecutive hours the dog is left alone during the day? never 1 2 3 4 5 6 7 8 9 10 11 12 more than 12 Do you have a dog door? Yes No If so, where? How many times a day is your dog exercised? 1 X a day 2 X a day 3 X a day 4 X a day What type of exercise? Is the dog allowed on furniture? Yes No Is the dog allowed on beds? Yes No Are there other pets in your household? If so, please list name, type & age:

3Your Dog's Behavior

How do you correct your dog?

Which of the following behaviors does your dog exhibit?

Which of the following aggressive/fear based behaviors does your dog exhibit?

4Agree to Terms

CANINE COUNSELING REQUIRES A 24 HOUR NOTICE PRIOR TO ANY CANCELLATION OR RESCHEDULING OF YOUR APPOINTMENT.
I understand that I will be responsible for full payment of a training session for failure to cancel or reschedule my appointment within 24 hours prior to my scheduled appointment.

TERMS OF PAYMENT
Full payment is either made on the first lesson or divided over the first three 1 hour lessons. Payment must be made at the beginning of the session in either check or cash. Please make checks payable to Brian Lee. If paying by credit card, payment must be made in full prior to the first lesson.

Do you agree with the above statements? Yes No