Gun Dog Training Enrollment Assessment

Owner's Name*

First Last

Email*

Phone*

Preffered Method of Communication*

Email

Phone Call

Text

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Additional family members

For children please list their ages.

How did you discover us?*

Tell us how you found QKdogs

Please elaborate on how you heard about us.

Which Gun Dog Program are you interested in?

Gun Dog Puppy Head Start (2 weeks estimate)

Gun Dog Foundation (4 week estimate)

Intermediate & Advanced Training

Pre Season/Year Round Tune Up

Private Lessons

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Are you ready to book immediately?

Yes

I would like to Fast Track my application with an Introductory ZOOM Call

30 Minute BASIC Q & A with QK Trainer ($50)

1 Hour IN-DEPTH Consultation with QK Trainer ($100)

Do you belong to any Sportsman's clubs?

Yes

No

If so, please list them below.

Canine's Name

First

Canine Breed

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OLD FIELD Birthdate (if known)

Date of Birth (if known)

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OLD FIELD Canine Age (approximate if birthdate is not known)

Canine Age (approximate if unknown)

Canine Gender

Spayed/Neutered?

If yes, at what age?

Has this dog bred and/or had puppies?

Please select any QK Dogs required vaccinations that your dog has received:

Bordetella/Parainfluenza (canine cough)

Canine Influenza

Distemper

Rabies

Be advised that dogs must be fully vaccinated before receiving services from QK Dogs. Canine Influenza is a two-part series; dogs will not be able to start services until 4-5 weeks after the first vaccine so please schedule with your vet accordingly.

Where did you get this dog?*

Do you plan to breed this dog?*

Did the breeder screen for common breed specific health issues (hips, elbows, EIC, CNM, Thyroid, Addisons, Eyes, etc.)?

Name of breeder, or explanation of where you got this dog

Did this puppy come from field and/or hunting lines/genetics? (Please explain)

Many hunting breeds are plagued with a variety of genetic disorders and diseases. Did the breeder screen for common breed specific health issues (hips, elbows, EIC, CNM, Thyroid, Addisons, Eyes, etc.)?

Please explain your breeder's screenings, if applicable.

Is your puppy EIC (exercised induced collapse) clear? Applicable to: Labrador, Chesapeake Bay Retriever, Curly Coat Retriever, Boykin Spaniel, Cocker Spaniel, & German Wirehaired.

Does this dog come with a health guarantee from breeder?

What was the dog's age when you acquired it?

How long have you owned this puppy?

Have you owned dogs before?

Has this dog ever been tested for tick diseases?

Tick Protection Type

Tick Protection Given On Date

Has this dog ever been diagnosed with Lyme, Erlichiosis, or Anaplasmosis tick diseases?

Last tested for tick disease (We require all dogs be tested for tick borne illnesses before gun dog training)

Heart Worm Protection Type

Heart Worm Prevention Given On Date

Food Brand

Amount you feed and times per day

Specific Variety of Food Brand

Why did you choose this food?

Supplements - please list

Probiotics - please list

We have found that supplements and probiotics help to keep our dogs healthy with a more balanced digestive system and stronger immune system. Would you like information about our supplements?

Medications (List, dosage, reason, times per day)

Based on all of these questions keeping in mind your dog’s breeding (genetics), age, experience, etc, How can we help you? Please be specific. What are your goals and expectations for our training programs? What would you like us to accomplish?

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OLD FIELD Date