Congratulations on taking the first step towards training with us. Please fill out the following form as accurately as possible. I make an effort to respond to new submissions within 48 hours, but may occasionally be delayed in responding or overlook a form. If you do not hear from me within 48 hours, please call 773-430-7768 and we will go from there. Looking forward to working with you and your dog!
Ruth Crisler, CBCC-KA
Type of consultation you wish to schedule
20 minute (free at our facility and certain events)
1 hour ($75 at our facility)
In-home ($95 and up, depending on your location)
Dog's Age (date of birth if known)
Dog's age when adopted or purchased
Sex of Dog
Breed or Type
Are your dog's vaccinations current?
Veterinarian or Veterinary Hospital with your dog's records on file
Reason for Behavior Evaluation
What is the main problem or concern?
Please check off any additional issues.
Urinates when excited or afraid
Mounts/humps people or objects
Overactive/doesn't settle easily
Nervous or easily stressed
Fearful or shy
Bolts through open doors
Pulls on leash
Doesn't come when called
Unresponsive to name or commands
Inattentive/short attention span
Steals food or objects
Guards food, toys or objects
Guards space or territory
Aggressive toward people
Aggressive toward dogs
Growls at family members
Has injured one more person
Has injured one or more dog
If guards, please explain.
If aggressive, please explain.
If has bitten or caused injury to a person, please explain.
If has bitten or caused injury to another dog, please explain.
If other, please explain.
Describe the most serious incident that has so far occurred (please note when this happened).
Describe the most recent incident.
How often is the main problem occurring?
Once a month or less
No more than once a week
Several times a week
Multiple times per day
This problem is increasing in
None of the above
What have you done to address or correct the above issues? (Please explain when and for how long.)
Were these methods effective? (Please explain.)
What of the above are your most urgent priorities?
What are your long-term goals for your dog?
Do you have a specific training program in mind for your dog?
How did/will you choose a trainer or training program?
How did you find See Spot Run?
How many adults reside in your household? (Please list.)
How many children? (Please list names and ages.)
What other pets do you own?
How many visitors come to the home on average each week?
Is your dog's interaction with any of the above a concern? (Please explain.)
Is this your first dog? If not, please list former dogs by breed.
In what style of home do you live? (House or apartment, how many stories, etc.)
Do you have a yard?
If yes, is it securely fenced?
Do you tie your dog out?
How much time does your dog spend in the yard unattended?
Where does your dog sleep?
Do you crate your dog? If so, when and how does he tolerate it?
Do you ever confine your dog to a room or area of the house?
How much time does your dog spend loose in the home unattended?
How did you choose your current dog?
Where did you purchase or adopt?
Do you know or were you given information regarding your dog's parents, littermates, or early history?
Is your dog social with new people?
Is your dog social with other dogs?
How much social interaction with other dogs has your dog had, either on-leash or off?
Do you visit dog parks or send your dog to daycare? If so, where and how often?
Describe your dog's play style or manner of interaction with other dogs?
Describe the methods you've used to train your dog in the past, including a list of training equipment your dog is familiar with.
If you have worked with a trainer or behaviorist previously, describe what that entailed.
Check off any commands or skills your dog knows or has.
Other commands or skills
If hand signals or other commands, please list.
What do you feed your dog, how often, and how much?
Is your dog under or overweight?
Does your dog suffer from allergies? (Please explain.)
Please list any current or recent medications. If current, please give dosage and schedule.
Has your dog been diagnosed with, or do you suspect, any medical conditions?
Has your dog ever suffered any serious injuries? (Please explain.)
If your dog has bitten, was it reported? Please give details.
Was skin broken, or medical treatment required? Please give details.
When did you first notice signs of aggression. Please explain.
Check any known or suspected aggression triggers.
Direct or heavy eye-contact
Approach or physical contact while eating
Approach or physical contact while resting
Approach or physical contact while having a toy
Other physical correction or punishment
Approach or presence of children or infants
Is there anything else in your dog's history that we should know?
Please confirm the following:
I verify all the above answers are accurate to the best of my knowledge.
Should be Empty: