Evaluation form C Evaluation Form Fields marked with an * are required SPACE About the Owner About the Owner Owner(s) Name: * Owner(s) Address: * City: * US States: * - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Zip Code: * Phone: * Email: * SPACE Divider SPACE About the Dog About the Dog Dog Name and Breed: * Dog's Age: Dog's Sex: Male Female Dog's Birthdate: Dog's Color: Dog's Weight: Has your dog been: Spayed Neutered Neither Is your dog currently on any medications? Yes No Please List your dog's medications (if applicable) Divider SPACE Dates of Last Vaccination Dates of Last Vaccination: DHLPP/DHPP Rabies Bordetella SPACE Divider SPACE HTML What are the primary reasons for contacting ExFed Dog Training? Goal #1 Goal #2 Where did you get your dog and how long have you had him/her? Are there any other pets in your home? Yes No Do they get along? Yes No Where does your dog sleep? When you leave your dog unattended, is he/she in a crate or left out in the house? Crate Out in House What is the type, frequency and duration of your dog's exercise? What type of collar and leash do you use on walks? Has your dog received any training? Yes No If yes, please describe your dog's training How do you or other family members stop unwanted behavior? Is your dog friendly toward people (familiar people, strangers, adults, children, etc.)? Yes No If not, please provide additional information Has your dog ever bitten a person or another dog? Yes No If yes, please describe what happened Is your dog friendly toward other dogs (familiar dogs, strange dogs, large dogs, small dogs, male dogs, female dogs, intact dogs, different breeds or colors, etc.)? Yes No If not, please provide additional information Does your dog protect or guard his/her food from people or other dogs? (growl, snap, or bite when people or other dogs interrupt your dog while eating or when they try to take away its food) Yes No If yes, please describe Does your dog protect or guard toys or other items from people or other dogs? (growl, snap or bite when people or other dogs try take away toys or other items from your dog? Yes No If yes, please describe Is your dog sensitive/uncomfortable with handling (touching ears, paws, other body areas)? Yes No If yes, please describe Does your dog ever act fearful? Yes No If yes, what types of stimuli trigger the fear (motion, sounds, touch, etc)? Please describe any behavioral concerns, personality "quirks" or issues that were not covered in previous questions: SPACE Divider SPACE HTML Nutrition Food—Brand Name: Supplement(s)—Brand Name/purpose: Is there anything else you feel we should know? Recaptcha If you are a human seeing this field, please leave it empty.