Obedience and Behavior Modification Assessment

PLEASE take the time to fill out this important form.

It will allow us to profile many important pieces that will help us to recommend which programs will work best for your dog.

Your dog’s breed, genetics, age, health, and background are an important part of the puzzle that helps us to learn how we can BEST help you!

Thank you for taking the time to fill out the form in detail so that we can best help you.

Upon submission you will typically receive a response with a program and trainer recommendation.

If you’re interested in hunting or field training with this dog, please complete a Gun Dog Assessment at Gun Dog Training Enrollment Assessment – QK Dogs.

"*" indicates required fields

Step 1 of 5 - Owner Information

Owner's Name*

First Last

Email*

Phone*

Preferred Method of Communication*

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 discovered QKdogs

Please elaborate on how you heard about us.

Which Obedience Program are you interested in?

Early Puppy Head Start Program (4-6 months) - 2 weeks approx

On Leash Program - 2 weeks estimated

Signature E-Collar Off Leash Program (6months and up)- 4-6 weeks approx

Private Lessons

Hidden

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)

Canine's Name

First

Canine Breed

Birthdate, if known

MM slash DD slash YYYY

Age (if birthday 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 - Every six months

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.

Why did you get this dog?

What interested you about this breed?

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

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

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)

Heartworm Protection Type

Heartworm Prevention Given On Date

How long have you owned this canine?

Food Brand and Variety

Amount you feed and times per day

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)

Does your dog live with other dogs? If so, list the age(s), breed(s), sex, spayed or neutered.

Human Interactions

Do you chase your dog?

Rough house?

Wrestle?

Play tug of war?

Does your dog like to lean on you, get into your space, sit on you?

Has your dog ever growled at you?

Bit you?

Growled at other people?

Bit other people?

Likes all people

Afraid of men

Afraid of women

Afraid of children

Not well socialized

nervous around people

Hyper around people

Jumps

Pulls on leash

Bites the leash

Barks

Is your dog upset being left alone?

Animal interactions - Please check all that apply

Afraid of other dogs

Tolerates other dogs

Loves all dogs

Wants to always play with other dogs

Plays rough with other dogs

Fights with other dogs

Has been attacked or hurt by other dogs

Humps/mounts other dogs

Goes to dog parks

Goes to Daycare

Chases small animals

Training Methods Used

Food/treats

Slip lead

Choke chain

Prong collar

Gentle leader

No pull harness

Regular harness

Regular flat buckle/clasp collar

Electronic collar

This dog has been invisible fence trained

Crate trained

Still using crate

Other

Have you been to a previous trainer(s)? Please explain

If other training method used, please explain

What type of exercise does this dog currently get?

Please describe the intensity of your dog's current exercise regimen

How does your dog respond to pressure? By 'Pressure', we are talking about you pulling on the leash, you getting into you dog's space, you making your dog do something he does not like (medicine in his ears, cutting his nails, giving him a pill).

Behavioral - Check all that apply

Barks a lot

Hyper

Lazy

Calm

Active

Fearful

Dominant

Submissive

Nervous

Busy, does not relax well

Dislikes car rides

Gets car sick

Skittish

Not very trusting of being handled and touched ALL over

Aggressive with people

Aggressive with dogs

Fights with dogs

Possessive of Toys

Confident

Stool/Poop eater

Eats/chews things

Pushy/in your space

Not house broken

Pees in crate

Destructive in house

My dog is an escape artist and has gotten out of crates, climbed fences and/or broken out of confinement. (This is very important to know so that we can properly house and contain your dog!)

Humps/mounts objects such as pillows, his toys, etc.

Humps/mounts people

In your home... (please check all that apply)

Dog is allowed on furniture

Dog is allowed in your bed

Dog has full run of my home

We have a doggy door

We have a fenced in yard

We have an invisible fence

Where does your dog sleep at night?

Crate

On a dog bed

Loose in the house

Family members' bedroom

In bed with a family member

In the basement

Outside loose

Outside on a tie out

Outdoor kennel

Eating Habits - Check all that apply

Free feed (food always out)

Finicky eater

Eats very well

Normal, respectful around food

Overly obsessed with food

Eats very quickly

Aggressive about food around people

Aggressive about food around dogs

Skin & Coat Condition (Check all that apply)

Needs regular brushing

Gets matted easily

Needs regular grooming/cutting

Dark skin pigment

Light skin pigment

Dry

Flaky

Sheds a lot

Itchy

Gets hot spots

Coat has strong odor

Thick coat stays wet, tough to dry

Normal coat

Excellent, shiny coat

Oily coat

Body Condition

Approximate Weight (numbers only)

Hidden

OLD FIELD Approximate weight

Coat Length

Does your dog have allergies?

If allergies, please explain.

Nails

Short

Medium

Long

Very Long

Black nails

Clear/light colored nails

Can you clip them?

Can you dremel/grind them?

Do you have a vet or groomer regularly cut nails?

Does your dog go to a Groomer regularly?

How does your dog behave at the vet and during vet exams?

Teeth Condition

Healthy white, clean

Some tartar (molars)

Moderate tartar

Lots of tartar

Missing any?

Any chipped teeth?

Do you brush dog’s teeth?

Do you give raw bones, Nylabones etc to help remove tartar?

Do you scale your dog’s teeth?

Eyes

Normal

Weepy/leaky

Accumulates discharge

Droopy eye lids

Has had eye surgery

Gets red and irritated

Has had Conjunctivits

Entropic

Cherry-eye

Digestional Health

Normal

Sensitive stomach

Bouts of IBS (Irritable Bowel Syndrome)

Frequently has loose stools

Frequently has diarrhea

Vomits frequently

Passes gas frequently

Eats grass regularly

Eats dirt

We offer AquaPaws water treadmill exercise at QK. Water treadmill aids to improve overall fitness, build endurance, improve muscle tone, assist with weight loss, and/or rehabilitate after injury or surgeries. Are you interested in adding aqua therapy to your dog’s experience for an additional charge? For our boarding, PLAYCARE+ and training dogs staying at QK this is a discounted service offered for $25 per workout (20 to 30 minutes of one-on-one exercise) if twice a week or more. The warm water helps soak sore muscles, burn extra energy for active dogs and is extremely soothing and therapeutic for overweight or older dogs. Read more on our website.

YES!

Not at this time

I'd like more information

What are your overall goals? Please explain how we can help you and what you would like our training program to help you accomplish with your dog