New Dog Intake Form Please complete and submit the below form prior to dropping your dog off with us! Unleashed Intake FormPlease only complete this form once requested by Gilles to do so. This form is for dogs that are scheduled in one of our programs. For multi-dog households, please complete 1 form for each dog. If you're looking to get started with us, please complete the "Get Started" form. Thank you!Owner InformationPrimary Client's Name(Required) First Last Address(Required) Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Email(Required) Phone(Required)How Did You Hear About Us? (If Referral, Their Name?)(Required) Dog InformationDog's Name(Required) Dog's Breed(Required) Weight (lbs)(Required) Gender(Required)Please select one...MaleFemaleAge (Years)(Required)Please select one...0-6 mos.6-12 mos.12345678910+Spayed/Neutered?(Required)Please select one...YesNoPrimary Vet Clinic(Required) Are Your Dog's Vaccinations Up To Date?(Required) No Yes Any Medical Issues, Allergies?(Required) No Yes If Yes, Please Explain: Household InformationList/describe any other animals in the household?(Required)List All Family Members In The Household? (Press Add Button To Add Another Person)NameAgeRelationship To YouPhone Number (Emergency Contact) Add RemoveWhen Did You Obtain Your Dog?(Required) MM slash DD slash YYYY Where Did You Obtain Your Dog?(Required) Housebroken?(Required)Please choose one...YesNoCrate Trained?(Required)Please choose one...YesNoOn Average, How Much Time Does Your Dog Spend Outdoors? (Walks, Play Time, Pee Breaks, etc.)(Required)Please choose one...< 1 Hour1 Hour2 Hours3 Hours4 Hours5 Hours6 Hours7 Hours> 7 HoursWhere Does Your Dog Sleep At Night?(Required)Where Is Your Dog Kept When You Leave The House?(Required)Tools You've Tried With This Dog? (Select All That Apply):(Required) Standard Collar Harness Choke/Prong Collar Head/Nose Lead (Halter) E-Collar Invisible Fence None If Your Dog Is A Rescue/Adoption, Describe What You Know About His/Her History Prior To You?Describe Any Previous Training Your Dog Has Had And The Organization/Trainer’s Name? What Was The Result?What Training Methods Have You Tried?(Required) Treats Verbal Praise Verbal Corrections Physical Corrections None/Other Describe 3 Things Your Dog Does That You Wish They WOULD NOT Do?(Required)Describe 3 Things Your Dog Doesn't Do That You Wish They WOULD?(Required)Does Your Dog Exhibit Any Of The Following? (Select All That Apply):(Required) Jumps on People Mouthing/Nipping Growling (at family, strangers, other dogs) Biting Family Biting Strangers Biting Other Dogs Potties in Home Steals Food/Trash/Objects Excessive Barking Digging Fearful/Anxious Destructive Doesn't Listen Reactive on Leash Pulls on Leash Primary Reason For Reaching Out For Support?(Required)EmailThis field is for validation purposes and should be left unchanged.
