Reactivity Questionnaire

Please fill in this form to give us more details about your dog, prior to attending your booked service:

Owner / Handler Information

Name:

email:

Phone:

Pet Information

Name of Dog:

Breed:

Sex:

Dog

Bitch

Neutered / Spayed:

Yes

Date of Birth

Birth Day:

Birth Month:

Birth Year:

Is your dog a rescue dog?

Yes

If yes, please give rescue centre:

When did you get your dog (estimate)

Owned Day:

Owned Month:

Owned Year:

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:

Month:

Venue:

I intend to pay via:

Where did you hear about Kay9 Services?

If 'Other' or 'Word of Mouth' please specificy:

Thank you for your interest in our company!

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