Date
              
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                    MM 
                   
                
                
                  
                    DD 
                   
                
                
                  
                    YYYY 
                   
                
               
            
            
            
            
            
        
          
          
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Name
              
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                    First Name 
                   
                
                
                  
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
            
            
              
                
            
              Email
              
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              Phone
              
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                    (###) 
                   
                
                
                  
                    ### 
                   
                
                
                  
                    #### 
                   
                
               
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Is it okay to text you? 
              
                * 
              
             
          
                Initial contact will always be by email. After the initial email and call, text may be helpful to coordinate sessions and provide invoice reminders. 
                
                
                
                
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Address
              
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                    Address 1 
                   
                
                
                  
                    Address 2 
                   
                
                
                  
                    City 
                   
                
                
                  
                    State/Province 
                   
                
                
                  
                    Zip/Postal Code 
                   
                
                
                  
                    Country 
                   
                
               
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Additional Owner / Handler
              
             
          
                
                
                  
                    First Name 
                   
                
                
                  
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              Are there other adults and/or children that live in the home with the dog? 
              
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                List name, age, gender, relationship and how often they interact with the dog. 
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              What services are you interested in?
              
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              Dog's Name
              
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              Dog's Gender
              
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              Is your dog spayed/neutered?
              
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              Dog's breed? 
              
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              Dog's approximate weight?
              
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              Dog's age? 
              
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              How long has your dog been with you? 
              
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              Where did you get your dog? 
              
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              Do you have additional dog(s) in the home?
              
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              What behavioral challenges are you experiencing with your dog?
              
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                How long has it been going on? Be as specific as possible. 
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Has your dog ever bitten a human? 
              
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              Has your dog ever bitten an animal? 
              
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              Has a veterinarian or other trainer ever recommended your dog for euthanasia? 
              
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              If you answered yes to the bite and/or euthanasia questions, please explain in detail.
              
             
          
                
                
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              Has your dog had any previous training? 
              
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                What type of training? For how long? What training tools were used? 
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Is your dog crate trained? 
              
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              Has your dog ever broken out of the crate, jumped a fence, dug out of an enclosure? 
              
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              Where does your dog sleep? 
              
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                Crate, dog bed, bedroom, free access in the home etc. 
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Has your dog ever gotten into a fight with another dog?
              
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              How does your dog behave around other dogs? 
              
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              Do you take your dog to the dog park or doggy daycare? 
              
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              How does your dog behave when guests enter the home?
              
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              How does your dog behave on the walk? What tools do you use when walking your dog?
              
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                What about if you come across a stranger? A dog? A squirrel? 
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              How does your dog behave around cats and/or other small animals (e.g. squirrels, rabbits)?
              
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              How does your dog behave around children?
              
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              Is your dog a possessive of toys, food, humans, areas of the home, etc.? 
              
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                What does this look like? How do they react if you approach or attempt to take the item away? 
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              How does your dog behave at the vet? 
              
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              How does your dog behave with grooming?
              
                * 
              
             
          
                Nail trims, brushing, ear cleans, etc. 
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Have you ever boarded your dog overnight?
              
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              How does your dog do on car rides? 
              
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              What are your top 3 important things you hope to accomplish with dog training? 
              
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              Veterinarian Name & Office 
              
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              Veterinarian Phone 
              
                * 
              
             
          
                
                
                
                  
                    (###) 
                   
                
                
                  
                    ### 
                   
                
                
                  
                    #### 
                   
                
               
            
            
        
          
          
            
            
            
            
              
                
            
              Does your dog have any important medical history that is important for us to be aware of?
              
                * 
              
             
          
                Be as detailed as possible. 
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Does your dog have any known allergies?
              
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              Is your dog on any medication? 
              
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              How much exercise does your dog get? 
              
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                What type of exercise? 
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              What amount of time does your dog spend outside?
              
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              What amount of time is your dog left alone during the day?
              
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              What do you feed your dog? How much? Do you feed at a specific time or free feed (e.g. leave food out all day)?
              
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              What do you do when your dog does something you don't like?
              
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              Is there anything else about your dog or your training goals that would be helpful for me to know?
              
             
          
                
                
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Have you reviewed the training options and prices on our website?
              
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              I understand that Because of Blair requires all clients to provide proof of vaccination, fecal analysis, and flea/tick medication for board & trains and structured boarding.
              
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              I understand that Because of Blair uses a balanced training approach and utilizes tools that include: food, slip leash, figure 8, prong collar, and/or e-collar.
              
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              By submitting this form you acknowledge that you are familiar with Because of Blair methods, techniques, programs, philosophies, and prices.
              
                *