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The Noble Beast Dog Training
Canine Training and Behavior Services
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Name
*
First
Last
Address:
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City
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Zip Code
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Phone Number:
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Email
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Preferred Day(s) for appointments:
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Monday
Tuesday
Thursday
Friday
Preferred Time(s) for appointments:
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Between 10 am - 6 pm.
Dog's Name
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Dog's Breed:
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Dog's birthday/Approximate age:
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Dog's weight:
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Sex of dog:
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Female
Male
Spayed or neutered:
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Spayed
Neutered
NA
Is your dog current on vaccinations (Distemper/Parvo & Rabies)?
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Yes
No
Has your dog been examined by a veterinarian within the last year?
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Yes
No
Name of Veterinary Hospital & Veterinarian if you see someone specific:
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Please list names and ages of all other pets in the house:
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Please list names and ages of all people who live in the house:
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Is your dog on any medication including over the counter supplements, preventative medications such as flea/tick or heartworm, behavior medications or other medications prescribed by your veterinarian?
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Appointment Type Requested:
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Foundation & Obedience Behaviors Puppy (under 6 months)
Foundation & Obedience Behaviors Adolescent/Adult (6+ months)
Aggression
Separation Anxiety
Fear or Stress Related Behavior
House Soiling
Other
If other, please describe:
Does your dog display any aggression toward people?
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Does your dog display any aggression toward other animals?
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Has your dog ever bitten anyone; people or other animals (including lunging or snapping but no contact or contact but no injury)?
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Has your dog received any previous training? Please list where and the name of the trainer.
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Please list your training goals for your dog:
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Are you and all members of the household committed to training and or a behavior modification plan?
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Yes
No
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