Basic Intake and Goal Assessment Final

Client & Dog Information
Guardians Name*
Date*
MM slash DD slash YYYY
Home Phone
Work Phone
Cell Phone*
Email*
How did you hear about us?
Dog's Name/ID*
Breed/Age/Sex*
Date of Adoption*
MM slash DD slash YYYY
Most recent vet visit and results:*
Dog's Routine
Describe your dog’s daily routine*
What does (Spot) do for exercise, and how often and for how long?*
What does (Spot) do when you’re gone from the house?*
What kinds of toys, chews, etc. does (Spot) play with, and how often? When does he/she play with his/her toys?*
Training History/Reinforcers
Have you done any training with (Spot), or had he/she done any before you adopted him?*
Where did you do the training? Can you describe the basic approach you learned to train your dog?*
Did you feel you got the results you were looking for?*
What are your dog’s favorite foods or treats?*
What are your dog’s favorite toys?*
What are your dog’s favorite activities?*
Client's Goals
What would you like your dog to do?*
What would you like to be able to do with your dog?*

Client & Dog Information