Contact information:
First name:
Last name:
Phone Numbers:
Email address:
Mailing address:
Request information on:
Dog Name:
Dog Age:
Dog Breed:
How long have you had your dog?
Where did you get your dog?
Name and Ages of children:
Other people who handle your dog:
Name, species, breeds and ages of other pets:	Species, Breeds, Age
Please list you dog's greatest training issues:
Please rank the following motivators from your dog's favorite(1) to least favorite (10):	treats, petting, walks, toys, people, other dogs, fetch, tug, sniffing
Please Check All That Apply to your dogs training (hold shift for multiple selections):	House Training Chewing Jumping Up Nipping Separation Anxiety Pulling on Leash Coming When Called Barking or Lunging at people Barking or Lunging at Dogs Guarding valued items Guarding owner Guarding Territory
Other Motivators:
What do you feed your dog and how often?
Allergies? If so, to what?
Sensitive Stomach?	Yes No
Picky Eater?	Yes No
How do you play with your dog and how often?
Name and Number of Veterinarian:
Date of Last Visit to the Vet:
How did you hear of Sit Stay Dog Training?