School of the Naked Dog

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The following questions will help us assess your situation with your animal companion.
We realise that there are many questions. Every question must be answered.

PERSONAL DETAILS
E-mail Address:
1. Your name
2. Address:
3. Suburb, and city:
4. Home phone number:
5 Cellphone:
6. How many people in your household- include children/adults
7. What other animals in your household?
8. How did you hear from us?
GENERAL DOG QUESTIONS
9. Name of Dog:
10. Breed:
11. Gender:
12. Age and birthday:
13. At what age did you adopt your dog?
14. How long have you had him/her?
BEHAVIOUR
15. Is your dog allowed on furniture/bed?
16. Where does your dog spend most of its day?
17. How many walks per day? length/ time
18. Type of walks per day
20. How does your dog react around children?
21. What kind of game does your dog enjoy?	Retrieving a ball and/or other objects Dog Tricks Walking and running Sleeping Other
22. Does your dog like being petted/ rubbed?
23. Does your dog have sensitive areas? Where?
24. Is your dog comfortable around other dogs?	Mostly yes Mostly no I dont know
25. How often does your dog socialise with other dogs
26. What is his reacton ON LEAD to other dogs?
27. What is his reaction OFF LEAD to other dogs?
28. Is your dog willing to share food, eat food near other dogs?
29. Did your dog socialiase with other dogs during its puppy period?
REACTIONS : How does your dog react to someone:
30. How does your dog react to someone knocking or ringing the bell?	Jumps Barks Scratches Lunges Ignores Not sure
31. How does your dog react to DOG walking past garden or yard?	Jumps Barks Scratches Lunges Ignores Not sure
32. How does your dog react to PEOPLE walking past garden or yard?	Jumps Barks Scratches Lunges Ignores Not sure
33. How does your dog react to DOGs coming into your property?	Jumps Barks Scratches Lunges Ignores Not sure
34. Does your dog have any problems with or ever shown unacceptable levels of the following...? (please tick as many boxes)	jumping mouthing digging ignoring commands humping standing over or dominating other dogs relieving itself indoors none
34a. Please explain any above behaviour
35. Has your dog ever growled at someone that you are concerned with?
36. Has your dog ever bitten someone that you are concerned with?
37. Is your dog ever anxious or frightened by a particular... (please tick as many boxes)	sound location type of person situation action noise not anxious or frightened
TRAINING
38. What rewards do you give?	Food Toy Praise Ball Nothing
DOG'S UNDERSTANDING OF ENGLISH Does your dog know how to:
39. Does your dog know SIT?	Yes No More or Less
40. Does your dog know COME?	Yes No More or Less
41. Does your dog know HEAL?	Yes No More or Less
42. Does your dog know OFF ?	Yes No More or Less
43. Does your dog know LEAVE?	Yes No More or Less
44. Does your dog know QUIET?to quiet him when he/she barks	Yes No More or Less
45. Does your dog know TOILET?	Yes No More or Less
46 Does your dog know STAY?	Yes No More or Less
47. Does your dog know DOWN?	Yes No More or Less
48. Does your dog know WAIT?	Yes No More or Less
HEALTH AND WELFARE
49. What do you feed your dog? product name
50. How often do you feed your dog?	Free feeding- he is allowed to eat when he wants Once a day Twice or 3 times per day
51. Have you used a groomer?
52. What type of collar do you use?	Nylon Choke Chain Halti Harness Muzzle Nothing
GENERAL QUESTION
53. What particular behaviour does your dog do that you feel needs help with?
54. Any other comment?
55. When is a good time to ring you or visit you for dog training/assessment?
We offer homestays for your dog. Instead of putting him/her in a kennel, your dog can stay with us, and fit into our lifestyle and family. If you think that you may use this service, please fill out the questions below. This is optional.
Dog Registration Number
Microchip Number
Vets name and phone number
PAYMENT and OTHER a few more questions
Payment of services: By checking this box, I understand that services must be paid on the first visit.
Receipt: I require a receipt for services rendered I dont require a receipt for services rendered
Newsletter: I would like to receive the monthly newsletter. I understand that I can unsubscribe at any time. I dont want to receive the monthly newsletter. I understand that I will be missing out on information about all new classes, new offers, ......new programmes. Visit our newsletter section. Click here and it will open a new window. You will not lose your information in this form.
Condition of Dog Training: By checking this box, I, the dog owner, agree and understand that the dog trainers at the School of the Naked Dog, will work directly with me and my animal companion to impart contemporary animal behaviour knowledge that best fits our needs, and that successful companion pet programmes depend on a combination of learned skills on the part of the pet and the owner. Trainers will make every reasonable effort to help us attain goals, but makes no guarantees of performance on the part of Owner or pet as a result of providing professional animal behaviour consultation.
Responsibility of Services: By checking this box, I understand that I, the dog owner, am responsible to get in touch with the dog trainers for any follow up visit. (please note, all follow up visit must be done within 3 months of the first visit)
Attach a photo of your dog (if you wish)

After you submit your form, you will receive an email, and the next webpage will explain some of the process around our visit. You can pre-pay the visit, or wait until we visit. However, payment must be made on the first visit.

@ Naked Dog Designs 2007-2011