Manners Registration Form -Tamara Tokash

Name of Guardian

Name of Dog (s)

Street Address

City

State

Zip Code

Daytime Phone

Cell Phone

Evening Phone

Email address

How did you hear about me?

Travel Radius Fee? (if applicable)

Breed/Mix/Hybrid

Age / DOB

Sex

Spay/Neuter/Ovary Sparing/Zinc Neutering date (if applicable)

Age Obtained?

Rescue/Shelter/Breeder/Other

Have you reared a dog before as an adult?

Yes

If so, what type of dog?

What motivated you to get this dog?

What are you hoping to accomplish?

What is your dog hoping to accomplish?

Name and address of Vet

Does dog have any known medical issues?

If so please describe

Is dog on any medication(s)?

What was the date (s) of last vaccine(s)?

1). What was the vaccine(s)? 2). Do you titer your dog?

Why are you seeking a consultation?

What exactly is your dog doing?

How often does it happen? Where When?

What are the objects of your dog’s behavior? Ie: Triggers such as men, dogs, doorbells, food, etc.

What are the immediate circumstances which lead to behavior? Ie: Petting, seeing another dog, left alone, possession of toys?

How do you respond/react to your dog in these situations?

Can you predict the behavior?

Yes

How long has the behavior been going on for?

How does your daily schedule/routine impact dog?

How long is your dog left alone?

Where is your dog when you leave?

Does dog destroy items, eliminate, mutilate themselves when alone?

Are there other pets in home?

Please describe a 24 hr period for your dog! Be specific.

Are there children in the home?

Yes

Does dog know any obedience words/cues?

What is the extent of your dog’s exercise/walks?

How many leash walks do you and your dog take per day?

How long are the walks?

What type of collar does your dog wear?

What type of lead/leash do you use?

What is your dog’s activity level?

Do you have a fenced in yard?

Do you have an invisible fence?

If so, how old was your dog when introduced to it?

What food(s) do you feed your dog? Please be specific

What treats do you give your dog?

Does your dog eat all of his/her food right away?

Yes

How many meals do you feed your dog / day?

Where does your dog typically gravitate to?

Does your dog seek out warmth or coolness?

Warmth

Coolness

Neither

Does your dog pant a lot?

Where does dog sleep in the evening?

What motivates your dog?

What are highlights of dog’s day?

Does he/she initiate play?

What obedience words/cues does your dog know?

What is dog’s reaction to a stranger?

Does dog mount people or dogs?

Yes

How much socialization did dog receive as a pup?

How does dog play with other dogs?

Does your dog growl, show teeth and/or snap while someone walks past while eating?

Does your dog growl, show teeth or snap when someone attempts to take a bone, toy, away?

Will your dog allow you to respectfully lie him/her on his back?

Has dog ever urinated on bed or sofa other than when a pup?

If your dog is in his/her favorite resting place can you easily move him?

If dog is under a piece of furniture will he/she growl … if you try to get them?

If you humanely discipline your dog does he/she growl …?

What is dog’s typical reaction when he/she meets other dogs?

Has dog ever growled, snapped or bitten a person or dog?

Please describe circumstance if applicable.

If there was a bite, did dog break skin?

When a guest walks into home does dog urinate and/or lunge?

Is dog fearful on walks or different surroundings?

Please describe how you respond to your dog in these situations.

Have you worked with a trainer before? If so for what?

How do you learn best? Visual/Audible/Kinesthetic?

Do you know if your dog's littermates are dealing with a similar situation?

Have any life events impacted your dog? ie: Returning to work, Child leaving for college, fireworks, etc.

Are you scheduling an 'IN-HOUSE session or a TELEPHONE consult?

Please fill out the Behavior and Manners Form and hit submit when finished. The form should take 20-30 minutes to complete. If you’re registering for behavior and have a short video (20 seconds or less) of your dog demonstrating the particular behavior(s), please send it to tamaratokash@gmail.com

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