General Intake Form

Please take the time to fill out this form to the best of your ability. Answering questions honestly and with detail helps Roam assess the best services and create a training plan for you and your dog.

Client Information

First name

Last name

Pronouns

She/Her

He/Him

They/Them

Other

Phone

Address

Emergency Contact

First name

Last name

Phone

Address

Services

Please check this box if you do NOT yet have a dog or puppy and are reaching out about services before you bring one home.

Do you have a start date or timeline in mind for the services you selected? If you are hoping for a Boarding or a Board and Train service during a particular timeframe, please list the start and end dates here.

Dog Information

Dog name

Dog breed and weight (your best guess)

Dog age

Dog age when you got them

Where did you acquire your dog?

Dog sex

Spayed female

Intact female

Neutered male

Intact male

Does your dog have any allergies, injuries, or medical conditions?

Name of veterinary clinic. Include your veterinarian's name if you tend to see the same person.

Behaviour and Temperament

How is your dog with other dogs and puppies? Are there any situations where your dog has big feelings about and/or does not get along with other dogs or puppies? (e.g., nervous around large dogs, gets excited and humps other dogs at the dog park)

How is your dog with cats?

How is your dog with strange humans? Are there any situations where your dog has big feelings about new humans? (e.g., nervous around men, barks at people carrying large bags, jumps on anyone who says hi, doesn’t like children).

Does your dog walk on a loose leash (without pulling)?

Yes, with frequent reinforcement

Yes, with occasional or no reinforcement

No, this is a work in progress!

How is your dog's recall ("come")? Please describe the situations in which your dog may not recall. What do you use to train the recall?

Does your dog ride well in the car?

Yes - they like and/or tolerate it

No - they do not like the car

If you checked off any of the above boxes, please describe the behaviour(s) in detail

Has your dog attended any of the following? Please check all that apply

Group walks (on leash)

Group walks (off leash)

Daycare

Boarding (kennel-style)

Boarding (in your or a trainer’s home)

Stayed with someone else (in someone else's home) overnight while primary humans were away

How comfortable is your dog in a crate? In what circumstances, if any, do you crate your dog?

How comfortable is your dog being handled and groomed by others? Are there specific things your dog is not comfortable with (e.g., nail trims, baths, brushing coat, burr removal, checking paw pads, etc.)?

Lifestyle & Exercise

How much exercise and training does your dog typically get each day? Please explain.

How would you describe your dog’s food drive?

Very high: will work happily and stay focused for low-value food (e.g., kibble) in all/most environments

High: will work happily and stay focused for low-value food (e.g., kibble) in familiar/easy environments, and will work happily and stay focused for medium-value food (e.g., beef liver) in most other environments

Medium: will work happily and stay focused for low-value food (e.g., kibble) only at home and in very familiar environments. Needs medium or high-value food in all/most outdoor and public access environments to stay focused.

Low: will not often work happily or stay focused outside the home, even with medium or high-value food. Often opts out of training or ignores cues with low-value food.

How many adults, children, and/or other animals live in the home? Please describe.

Training History & Goals

What training have you previously done with this dog? (e.g., private lessons with a trainer, group puppy classes, agility classes, etc.)

What is currently the *most common* combination of training equipment/tools you would put on your dog for a typical training outing in a distracting environment?

What is your main goal for training (or other services) with Roam?