New Client Registration | Apex Canine

Name *

First

Last

Email *

Phone Number: *

Please list all members of household (please highlight any minors living in the home and include their age):

Please list all other animals living on the property below and include Name/Age/Species/Living Conditions (in-home, enclosure, barn etc):

Is this your first dog that you are the primary caretaker for?

Yes
No

How did you hear about us? If referred to us, please let us know who sent you so we can thank them:

Google Search
Facebook
Customer Referral
Other

Dog's Name:

Breed

Current Age:

When did they join your family? Include age as well if known. *

Is your pet up to date on vaccination? *

Neutered/Spayed?

Yes
No

Date (approx) of most recent Vet Exam:

Has your dog ever been seen for anything other than routine care at the vet? (Please explain below) *

Does your dog have any known allergies or medical conditions?

Please list all medications your dog is currently taking including dosage:

Please list all supplements your dog is currently taking including brand & dosage:

What food is your dog currently eating? Please include brand, specific formula/flavor, dry/wet, as well as how much and how often they are fed:

Please describe your feeding routine (where is your dog fed, do they have their own space to eat etc):

What, if any, history do you know of your dog’s life experiences & living conditions prior to their arrival to you? (In-home breeder, kennel, stray , surrendered, spent time in foster home etc)

Please describe your home environment. This includes details such as type of housing (house/apartment/trailer/rv), the surrounding area (woods/farmland/city/neighborhood), and how heavily trafficked the area is:

Has your dog cohabitated with any of the following (dog, cat, small animals, livestock, child under 10, toddler, infant). Please describe:

Has your dog ever interacted with any of the following (dog, cat, small animals, livestock, child under 10, toddler, infant). Please describe:

Has your dog ever displayed aggression towards, attempted to bite, or bitten, another animal or human?

Yes
No

If you answered yes to the above, please explain below. Please include information on any injuries sustained, if medical treatment was needed, if animal control was involved etc:

Have any other animals in the home displayed aggression towards, attempted to bite, or bitten, another animal or human? This is for my safety and awareness.

Yes
No

If you answered yes to the above, please explain below:

Please list all current behavior concerns below:

Does your dog have any previous training experience? Please describe below and include details on what skills were worked on, what tools/equipment were used, and your overall impressions from that experience:

Please describe any training experience you have had with other pets in the past:

Please describe any and all management tools or strategies you have used or are currently using. This may include things like gates/x-pen/tether/muzzle/crate/safe space/walking at certain times/limiting access to certain items etc:

What equipment are you using for your dog currently? Ex: Martingale collar, flat collar, harness, 6ft leash, long line etc

Please describe your dog’s daily routine and include information on what type of exercise/enrichment they currently receive?

In your opinion, is your dog currently receiving enough exercise/enrichment?

Where does your dog sleep?

In your opinion, is your dog currently getting sufficient and good quality rest?

Where is your dog left when home alone?

How often, and for how long, is your dog typically home alone?

Does your dog’s current environment/routine cause them to interact with any triggers currently? This can include dogs, unknown people, wildlife, cars, reflective items, “things with wheels”, equipment, handling, being left alone etc Please list and describe below:

What are your training goals? What do you hope to achieve for your sessions?

Is there any additional information you would like to share?

Do you have any scheduling preferences or restrictions we should make note of prior to scheduling your free discovery call? (Please note if there are any specific days of the week or times of day that do not work for you.)