Client History Form

Owner Name (required)

Email (required)

Occupation (required)

Phone (required)

Your Address (required)

YOUR DOGS DETAILS

Dogs Name (required)

Breed (required)

Age (required)

Weight (required)

Gender (required)

Current Diet (required)

Please provide details of any supplements and reason: (required)

Please provide details of any behavioural concerns, including whether the dog has bitten a human or other animal: (required)

YOUR DOGS MEDICAL HISTORY

Name of vet

Phone Number

Address

Email

Please provide any details of any current medical conditions:

Is your dog currently under ongoing veterinary care for any condition:

Please provide details of any medications your dog is on:

Please provide details of any previous surgeries:

Does your showing any of the following:
Restless sleepFidget whilst restingHave problems settlingExcessive bowing/stretchingYawningChange in appetiteChange in drinking behaviour

YOUR CURRENT GOALS

What are your current goals with your dog?

Do you think your dog has a current injury? (please provide details)

Are there any weaknesses you think your dog needs working on?

Have you noticed any functional problems with every day activities?

What are you hoping to achieve by visiting Superfly Dog Training?

CURRENT TRAINING AND FUNCTIONALITY

On an average day how much and what type of exercise does your dog get?

In an average week, please describe how much training/competing does your dog get?

What mental games do you engage with your dog?

What of following activities does your dog do?
AgilityFlyballObedienceRallyConformation/ShowingDock DogNose WorkField trialsGun dogHerdingSled/weight pullingOther

Do you have any of the following exercise equipment?

TreadmillBalance cushion (sm)Balance cushion (lg)Wobble board (sm)Wobble board (lg)K9 FitboneDonutPeanutCavalettiPaw podsStepLadderOther

Any other relevant information