Group Class Application in Fairfax, VA | Fairfax Veterinary Hospital

Client Name:

Pet’s Name:

Gender:

Date of Birth:

Address

Street Address

Contact Number:

Email

Which Class are you applying for:

How does your dog respond to being on leash with other dogs nearby (within 20 feet)?

How does your dog respond to being on leash with other people nearby (within 20 feet)?

Why do you feel a group class is the right fit for you and your dog?

What issues are you currently experiencing with your dog?

List all of the goals you would like to accomplish by the end of this course?

Rate your dogs food motivation on a scale of 1-10, 1 being lowest:

Rate your dogs toy motivation on a scale of 1-10, 1 being lowest:

Does your dog have any food allergies or sensitivities? If yes, please specify.

Please specify.

How may we contact you in event of any necessary communication or class cancellation? Text Email Cell phone Other

Is there anything else you feel we should know about your dog?

Is your dog up to date on Vaccinations? (Rabies, Distemper, Bordetella)?

Does your dog have a normal fecal result within the last year?

Does your dog have an up to date annual within the last year?

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