About You First Name * Last Name * Address
* Email *
Phone * Occupation * About Your Pet Your Pet's Name * Your Pet's Age Range * Date of Birth (or best guess) * Your pet's weight * Gender * Neutered Male Spayed Female Unaltered Male Unaltered Female How old was your pet when they were spayed/neutered? * Do you plan to have your pet spayed / neutered in the future? * Yes No Breed *
If mixed, your best guess.
Color / Unusual Markings * How long have you had your pet? * Where did you obtain your pet? *
(For example, from a breeder or from the shelter)
Other Household Members *
Including other pets, please provide the following information for every member of your household. To add more members, click the plus icon.
Does your pet get along with everyone in the household? * If no, please explain * Who will be responsible for practicing training exercises with your pet? * Is your pet frightened of any household members, and if yes, please explain Type of Residence *
Do you live in a house, townhome, apartment or something else?
If you have a yard, what type of fencing surrounds it? * No yard Yes, chainlink Yes, privacy Yes, invisible No fence Other Is your pet current on his/her vaccinations? * Your Veterinarian's Name *
* Date of last Veterinarian visit? *
MM slash DD slash YYYY
Please list any of your dog's current or past medical issues. * May I discuss your dog's behavioral and/or medical issues with your Veterinarian? * Is your pet easily handled by veterinarian staff? *
For example, has your dog ever had to be muzzled?
Does your pet have any allergies? * If yes, please list. * What brand and type of food do you give your pet? *
How much and how often do you feed your pet? *
(ex. 1cup twice daily)
What time(s) do you feed your pet? *
(ex. 7am and 7pm)
Does your pet finish all the food at each meal? * If no, how long is the food available to your pet? * What other treats do you give your pet? * Has your pet ever become possessive of his food or a treat or toy? *
If yes, please explain in as much detail as possible.
Where is your pet kept when you are not at home? *
(For example, in a crate or in the back yard)
How long is your pet confined to a crate/kennel each day? * How many hours per day is your pet without human companionship? *
(how much time does your pet spend alone?)
Where does your pet sleep at night? * Please describe your pet's daily exercise. * How does your dog react to other people/dogs he meets on walks? * Describe your pet's reaction to the last person who visited your home. * Describe training methods you have used with your dog. *
(For example, verbal corrections, physical corrections, food treats, praise)
Select all training/management equipment you currently use on your dog, or that you have used on your dog in the past * Flat Collar Harness Leash 6 ft long or shorter Leash longer than 6ft Martingale collar Head halter Choke collar or slip lead Pinch or prong collar Electronic or vibrating collar Other (please describe) Please describe any other equipment used on your dog What made you decide to use the equipment listed above? * Has your dog ever participated in play at a dog park, daycare or play group? Please describe your dog's behavior/attitude (any issues? never been?) at dog park, daycare and/or playgroups * Has your pet ever bitten/scratched anyone? *
If yes, please describe in as much detail as possible.
What are the specific behaviors your dog is exhibiting that prompted you to contact a trainer? * What are your expectations with regard to training your dog? * List 3 things you like about your pet. * Please list anything else you feel it's important for me to know. * Agreements and Other Stuff So that I may give thanks, how did you hear of Over the Moon Training? * Hidden (Hidden)May I add your email address to my newsletter subscription list?
Check the box below if you would like to receive email updates of upcoming classes and events offered by Over the Moon.
Occasionally Over the Moon uses photos and videos from their sessions in instructional, promotional and marketing materials. By clicking the box above, I hereby grant permission to Over the Moon Training Services, LLC the rights of my image, in video or still, and of the likeness and sound of my voice as recorded on audio or video without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed, and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.
Photographic, audio or video recordings may be used for any use which may include but is not limited to presentations, courses, online/internet videos, media, and the news (press).
I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the internet or in the public educational setting.
I will be consulted about the use of the photographs or video recording for any purpose other than those listed above.
There is no time limit on the validity of this release, nor is there any geographic limitation on where these materials may be released.
By clicking the box above I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes. I agree to the video release policy stated above. Email
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