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Reactivity Questionnaire
Please fill in this form to give us more details about your dog, prior to attending your booked service:
Please leave blank:
Owner / Handler Information
Name:
email:
Phone:
Pet Information
Name of Dog:
Breed:
Sex:
Dog
Bitch
Neutered / Spayed:
Yes
No
Date of Birth
Birth Day:
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Birth Month:
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Birth Year:
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Is your dog a rescue dog?
Yes
No
If yes, please give rescue centre:
When did you get your dog (estimate)
Owned Day:
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Owned Month:
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Owned Year:
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Is your dog undergoing any veterinary care at present? Please provide details:
Does your dog have any special needs/allergies? Please provide details:
Pet Behaviour Information
How does your dog react to other dogs?
Has your dog bitten another dog before?
(if yes pls give details and number of incidents):
If yes, did the bite recipient have to go to a vet and if so, what treatments was given?
How does your dog react to unfamiliar people?
Has your dog bitten a person before?
(if yes pls give details and number of incidents):
If yes, did the bite recipient have to go to a hospital and if so, what treatments was given?
State briefly your hopes of achievement through training?
Current level of training & School Attended:
Details of Service:
Date:
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Month:
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January
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Venue:
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Hawley
Mytchett Community Centre
Yateley
Kay9 Haven
Other - Misc
I intend to pay via:
Select Payment Method
Cheque on the day
Cheque in the post
Cash on the day
Bank Transfer
PayPal (incl Admin Cost)
Where did you hear about Kay9 Services?
Facebook
Vet
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If 'Other' or 'Word of Mouth' please specificy:
Submit
Thank you for your interest in our company!
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