*Required fields PLEASE TELL US HOW WE CAN BEST SERVE YOU: |
Services Requested: (Please select all that apply. To select more than one item, press CTRL key while clicking on the selection.) |
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Reason for contacting
Daiger Dog Training, LLC |
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PLEASE TELL US ABOUT YOURSELF: |
First Name*: |
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Last Name*: |
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Address: |
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City: |
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State: |
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Zip: |
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Home Phone*: |
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Cell Phone: |
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Other Phone: |
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E-Mail*: |
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We prefer to be contacted by: |
Phone Email Either |
How did you hear about us? |
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Referral Name |
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YOUR DOG'S INFORMATION: |
Name of Dog: |
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Breed/Type: |
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Age: |
yrs. mos. DOB: |
Gender: |
Spayed or neutered? Yes No
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Approximate Size of Dog: |
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Where obtained? |
When Obtained
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Please list other dogs you have: |
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Your Veterinarian or Veterinary Clinic: |
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Vet Phone: |
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Is your dog current on vaccinations? |
Yes No
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Has your dog ever bitten a person? |
Yes No
If "yes", how severe?
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Has your dog bitten another dog? |
Yes No
If "yes", how severe?
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Has your dog ever exhibited any form of aggression toward:
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Is your dog reactive (barking, lunging) near other dogs? |
No Slightly reactive Yes
(explain):
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Can you control your dog when around other dogs? |
No Moderate Control Yes
(explain):
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Please tell us anything about your dog's background that you think might be helpful to us:
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Please enter 7845 in box: |
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