PUPPY CLASS INTAKE QUESTIONNAIRE

Puppy Class Intake Questionnaire

Please complete before your first class so we can tailor the group to your puppy's needs.

Owner Information

Owner Name

Co-Owner(if any)

Address

Phone

Email

Emergency Contact (name & phone):

How did you hear about us?

Puppy Information

Puppy's Name

Breed/Mix

Date of Birth

Month

Day

Year

Sex

Spayed/Neutered

Approximate Weight

Source (breeder, shelter, rescue — name if known):

Date you brought puppy home:

Month

Day

Year

Veterinary Information

Veterinary Clinic Name:

Clinic Phone

Vet's Name

Vaccination status (check all that apply, and note dates if known):

DHPP / Distemper series — in progress or complete

Bordetella

Rabies (if age-eligible)

Other / notes:

Proof of an age-appropriate, vet-approved vaccination or titer status is required to attend group class. Please bring a copy of your puppy's vaccine record to your first session.

Health History

Any known allergies (food, environmental, medication)? If yes, describe:

Any current medications or supplements? If yes, list:

Any diagnosed medical conditions (heart, joint, seizure, GI, skin, etc.)? Describe:

Any recent illness, injury, or surgery? Describe:

Any physical limitations that affect exercise or handling? Describe:

Behavior & Socialization History

Home Life

Who lives in the household (adults, children with ages, other pets)?

Temperament & experience — please rate or describe:

How does your puppy react to new people (adults, children, strangers)?

How does your puppy react to unfamiliar dogs?

How does your puppy respond to loud noises, traffic, or new environments?

Any history of resource guarding (food, toys, chews, spaces)?

Any history of nipping, mouthing, growling, or snapping — at people or other dogs?

Any signs of fear, avoidance, hiding, or shutting down in new situations?

Has your puppy had a negative experience (a scare, an attack, a painful vet visit, etc.)? Describe:

Training so far

Cues puppy already knows (sit, wait, name recognition, etc.):

Training methods/tools used so far (treats, clicker, prong/e-collar, etc.):

Top 2–3 Goals for the Class