Canine Conditioning Application Form Primary ContactFirst Name* Last Name* Email Address* Enter Email Confirm Email HiddenCamera On Off Mobile Phone*Alternate PhoneAddress* Street Address City State*AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Secondary ContactFirst Name* Last Name* Email* Enter Email Confirm Email PhoneAlternate PhoneRelationship* HiddenAddress Street Address City State*AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code People authorized to pick up your pets* Pet InformationYour Dog's Name* Gender* Female Male Spayed or Neutered* Yes No Breed*Select OneAffenpincherAfgan HoundAiredale TerrierAkitaAlaskan MalamuteAmerican English CoonhoundAmerican Eskimo DogAmerican FoxhoundAmerican Staffordshire TerrierAmerican Water SpanielAnatolian Shepherd DogAustralian Cattle DogAustralian ShepherdAustralian TerrierBasenjiBasset HoundBeagleBearded CollieBeauceronBedington TerrierBelgian MalinoisBelgian SheepdogBelgian TervurenBernese Mountain DogBichon FriseBlack and Tan CoonhoundBlack Russian TerrierBloodhoundBluetick CoonhoundBorder CollieBorder TerrierBorzoiBoston TerrierBouvier des FlandresBoxerBoykin SpanielBriardBrittanyBrussels GriffonBull TerrierBulldogBullmastiffCairn TerrierCanaan DogCane CorsoCardigan Welsh CorgiCavalier King Charles SpanielCesky TerrierChesapeake Bay RetrieverChihuahuaChinese CrestedChinese Shar-PeiChinnokChow ChowClumber SpanielCocker SpanielCollieCurly-Coated RetrieverDachshundDalmationDandie Dinmont TerrierDoberman PinscherDogue de BordeaxEnglish Cocker SpanielEnglish FoxhoundEnglish SetterEnglish Springer SpanielEnglish Toy SpanielEntlebucher Mountain DogField SpanielFinnish LapphundFinnish SpitzFlat-Coated RetrieverFrench BulldogGerman PinscherGerman Shepherd DogGerman Shorthaired PointerGerman Wirehaired PointerGiant SchnauzerGlen of Imaal TerrierGolden RetrieverGordon SetterGreat DaneGreat PyreneesGreater Swiss Mountain DogGreyhoundHarrierHavaneseIbizan HoundIcelandic SheepdogIrish Red and White SetterIrish SetterIrish TerrierIrish Water SpanielIrish WolfhoundItalian GreyhoundJapanese ChinKeeshondKerry Blue TerrierKomondorKuvaszLabrador RetrieverLakeland TerrierLeonbergerLhasa ApsoLowchenMalteseManchester TerrierMastiffMiniature Bull TerrierMiniature PinscherMiniature SchnauzerNeapolitan MastiffNewfoundlandNorfolk TerrierNorwegian BuhundNorwegian ElkhoundNorwegian LundehundNorwich TerrierNova Scotia Duck Tolling RetrieverOld English SheepdogOtterhoundPapillonParson Russell TerrierPekignesePembroke Welsh CorgiPresa CanarioPeruvian Inca OrchidPetite Basset Griffon VendeenPharaoh HoundPlott HoundPointerPolish Lowland SheepdogPomeranianPoodlePortugese Water DogPugPuliPumiPyrenean ShepherdRedbone CoonhoundRhodesian RidgebackRottweilerSalukiSamoyedSchipperkeScottish DeerhoundScottish TerrierSealyham TerrierShetland SheepdogShiba InuShih TzuSiberian HuskySilky TerrierSkye TerrierSloughiSmooth Fox TerrierSoft Coated Wheaten TerrierSpinone ItalianoSpitzSt. BernardStaffordshire Bull TerrierStandard SchnauzerSussex SpanielSwedish VallhundThai RidgebackTibetan MastiffTibetan SpanielTibetan TerrierTosaToy Fox TerrierTreeing Tennessee BrindleTreeing Walker CoonhoundVizslaWeimaranerWelsh Springer SpanielWelsh TerrierWest Highland White TerrierWhippetWire Fox TerrierWirehaired Pointing GriffonXoloitzcuintliYorkshire TerrierOtherList Predominant Breeds* Dog's Weight* Dog's Birth Date* MM slash DD slash YYYY Is birth date actual or estimated?* Actual Estimated How long have you owned your dog?* Does your dog have any health concerns we should know about?* No Yes Please describe all health concerns* Please describe* Who is your primary Veterinarian?* Phone*Address* Street Address* City* AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State* Zip Code* Is there a secondary Veterinarian? Yes No Phone*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code If you have your pup's vet records handy, please add them here. Otherwise, we're happy to reach out to your vet for them.Max. file size: 50 MB.Health HistoryDoes your dog have any allergies?* Yes No Please explain your dog's allergies* Does your dog have any physical disabilities?* Yes No Please explain your dog's physical disabilities* Does your dog have any medical conditions?* Yes No Please explain your dog's medical conditions* What restrictions need to be placed on your dog's activities or movements? (check all that apply)* No jumping No running No hard play Other None Please explain "other"* Does your dog have any sensitive areas?* Yes No Please explain* How frequently is your dog walked outside?* How long are your walks outside?* Please indicate the choice that most accurately represents your dog's overall level of exercise* Athlete - regular jogs/runs; participation in a dog sport activity such as agility, flyball, frisbee, etc. Moderate exerciser - long or multiple walks daily; regular playtime with human or other dogs Mild exerciser - short daily walks and/or regular playtime with human or other dogs Less than moderate exerciser - spends most of the day sleeping; occasional walks; occasional playtime with humans or other dogs Which commands does your dog know? (check all that apply) Select All Sit Stay Down Come Heel Rollover Kisses High five Other Please list other commands* Has your dog had any obedience training?* Yes No How was obedience training administered?* Attended one group class Attended more than one level group classes (beginner, intermediate, etc.) Sent to board and train program Private sessions in home Other Untitled* Which of the following best describes the use of obedience cues with your dog at home?* Key part of daily communication Used when we go on walks or have people over Used occasionally to better control behavior Rarely used Does your dog have any problems in any of the following areas? (check all that apply) Mouthing Housetraining Barking Digging Ignoring commands Chewing How would you describe the energy level of your dog?* Low Medium High Does your dog enjoy playing with toys?* Yes No What kinds of toys does your dog enjoy playing with?* Please list any comments or other information about your dog that you feel may be helpful.Additional InformationHow did you hear about us?* Drove by Yelp Facebook Printed ad Referred by my vet Referred by an existing customer Other Referral information* Please describe* Great! Please be sure to also complete our Off-Leash Play application. Thanks!PhoneThis field is for validation purposes and should be left unchanged. Δ ShareTweetShare0 Shares