Name
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First Name
Last Name
Phone
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(###)
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Email
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
What service(s) are you interested in?
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How did you hear about us?
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Dog's Name
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Date of Birth
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MM
DD
YYYY
Breed
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Weight (approximate)
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Gender
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Reproductive Status
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How long have you owned your dog?
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Are there other adults or children that live in the home with the dog?
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What are their names, relationship to the dog, age, and gender?
What other pets live in your home (species/age/sex)? How does your dog get along with the other pet(s)?
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Please list any other animals in the home. If none, write N/A.
Veterinarian Name
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Veterinarian's Address
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Veterinarian's Phone Number
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(###)
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Does your dog have any important medical history we should be aware of or keep an eye out for? Please be specific
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Is your dog medically cleared by vet, does the injury still cause pain, will it prevent him doing certain physical activities or training?
Any known allergies, special medical needs, or medications? Please list with details
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What do you feed your dog? Is your dog free-fed (bowl left out all day long) or does he/she eat all of the food at mealtimes?
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Please include brand, amount fed, and when you feed your dog (e.g. raw, dry kibble, canned)
What behavioral problems have you been experiencing with your dog? How long has this been going on? Be very specific here
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Has your dog had any previous training? Did the trainer use any tools?
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Example: gentle leader, harness, slip lead, prong collar, e-collar, etc.
Does your dog have separation anxiety?
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Where does your dog sleep?
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Example: in crate, bedroom, dog bed, your bed, free access to home, etc.
Is your dog crate trained? Are you willing to continue crating your dog after training if recommended to be best for your dog?
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If yes, how does it do in the crate and when do you use the crate? If no, please explain why. Example: are they calm and quiet or do they struggle with whining?
Do you currently or in the past gone to dog parks or doggy daycare? How does your dog behave?
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How does your dog do interacting with other animals both in the home and out in public?
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How does your dog behave around cats?
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Never been around cats Respectful Friendly/playful Aggressive Frightened Ignores or is indifferent Gentle/submissive Chases for fun Chases to harm Has injured / killed a cat
How does your dog act when guests enter the home?
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Example: are they fearful, aggressive, excited?
Has your dog ever broken out of the crate or jumped a fence? Please explain
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Has your dog ever been boarded overnight before?
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How does your dog behave at the vet?
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Example: are they fearful, happy, nervous, aggressive, etc.
How does your dog behave on a walk? What tools do you use to walk your dog (gentle leader, front clip harness, slip lead, etc.)?
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Do they react to people, dogs, bikes, skateboards, cars, kids, strollers, etc.
Is your dog possessive of food, toys, bones, bed, humans, etc? How are they when approached or if items are taken away?
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Has your dog ever bitten or attempted to bite another dog or person? If yes, did the bite break the skin?
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Does your dog exhibit signs of high prey drive? Do they chase and/or fixate on small animals?
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Example: squirrels, bunnies, birds, cats
Is your dog invisible fence trained?
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Do you discipline your dog? If yes, how do you discipline your dog? If no, please explain why.
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What are your training goals? What is most important for you to accomplish?
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I understand On the Mark Balanced Training requires all dogs to provide proof of vaccines, fecal analysis, flea and tick medications.
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I understand that On the Mark Balanced Training uses both rewards and discipline as the basis of training and/or behavior modification.
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By submitting this form you acknowledge that you are familiar with On the Mark Balanced Training methods, techniques, programs, philosophies, and prices.
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All training fees must be paid in full prior to leaving the premises after a lesson or upon picking up for a board and train.
