The Canine Campus
Training & Wellness Center
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Questionnaire — Digital Submission

Questionnaire Digital Submission

Fill out the form below to submit your Questionnaire to The Canine Campus.

We will have you sign a printed Waiver when you come to our facility, or you can print and sign one here: Waiver Form (PDF). 
If you prefer to print a combined form you can access that here: Combined Questionnaire + Waiver Form (PDF).


The Canine Campus — Questionnaire

Is this for a private session? *
If for a private session indicate whether:
Owner Name: *
Owner Name:
Owner Address: *
Owner Address:
Home Phone:
Home Phone:
Work Phone:
Work Phone:
Cell Phone:
Cell Phone:
Best method to contact: *
If a friend, please give us their name so we can send them a thank you!
If a friend, please give us their name so we can send them a thank you!
Dog Gender: *
Name / Relationship / Age / Hours Away from Home
Name / Type + Breed / Age / Where Acquired From
When was the last physical examination performed on your dog? *
When was the last physical examination performed on your dog?
Have there been any medical tests performed associated with the behavioral problem? *
If yes, please obtain a copy of all medical tests performed and submit to The Canine Campus.
Is your dog spayed or neutered? *
If no, are you planning on breeding your dog?
Does your dog have any preexisting or current medical problems? *
Has your dog ever had a seizure? *
Does your dog have any food allergies or restrictions? *
Please verify that your dog is current on the following vaccines *
(must be within the last year)
Bordatella is not a standard vaccine and is typically not given unless requested. Please verify that your dog has had it or schedule an appointment to get it! No exceptions will be made. This is to protect your dog and the others in class. *
For Bordatella, the dog must be vaccinated with the intranasal vaccine at least one week (7 days) prior to class. If your dog has received the injectable vaccine and it is the first Bordatella he had in his life, it must be bolstered 2-4 weeks after the initial vaccine, and again must be given at least a week before starting classes.
Have you had pets before? *
Please select all that apply: *
Why did you get this dog? *
Select all that apply
Describe your dog as a puppy: *
Select all that apply
Describe your dog as it is now: *
Is your dog... *
Do you routinely play with your dog? *
What is the living situation for you and your dog? *
Is your dog fed: *
Is your dog fed treats on a daily basis? *
Is your dog allowed on furniture? *
Where is your dog when it is left home alone? *
What is your dog's obedience school history? *
Is your dog trained to go to a certain spot/location (e.g. bed, crate, mat) on a verbal command? *
What commands does your dog know and routinely does when told? *
Does your dog have behavioral problems that you wish to address? *
If no, you can skip to the end of the questionnaire.
How much of a problem do you consider the behavior to be?
Can you determine any patterns with which this behavior occurs?
For example, is it always after company leaves, always after dinner, etc.? No matter how small, if you have noticed it, it could be pertinent.
Has the frequency of the behavior:
Has the intensity of the problem:
Have there been any changes in the household?
New dog, new family member, schedule change, etc.
Please list all things you have tried whether they have been useful or not.
Have you considered finding another home for your dog?
Have you considered euthanasia (putting your dog to sleep)?