RDP Questionnaire and RegistrationPlease take a moment to complete the following questions about you and your dog: BackgroundDate *Your Name *Address *Email *Phone *Emergency contact (Name/Phone) *How did you hear about Canine Karma? *Veterinarian Name, Address, and Phone number *Include the hospital name.Recent Vaccine Records *We must have a copy of your dog’s most recent vaccines: DHPP, Rabies, Bordatalla. Upload a photo or document. (Must be png, jpeg, gif, or pdf)Negative Fecal Test *Upload a photo or document of proof from your veterinarian that your dog has produced a negative fecal test in the last 6 months. (Must be png, jpeg, gif, or pdf)Please list other adults and children (ages) living in your household: *What is the name, age, sex, breed of your dog? *Where did you obtain your dog and how long have you had him/her? *What age was your dog when you acquired him or her? *Other dogs or pets in Household (name, age, breed) *In what order did you obtain each pet? How much time elapsed between each pet? Have you ever done any private training or training classes with your dog? *YesNoIs your dog friendly to humans and other dogs? *YesNoHas your dog ever appeared frightened or aggressive to any person or dog? *YesNoDo you have any background information about your dog? *Do you know anything about the parents or siblings of the dog? *If you got your dog as a puppy, what sort of socialization did you do when he/she was young? *Did you notice any issues with your puppy when it was young? *Why are you seeking a consult for your dog? *By seeking our service, what goals do you have for you and your dog? *PhysicalDoes your dog have physical problems, limitations, issues? *If so, please describe and include if he is seeing a veterinarian for this condition? *Is your dog under a care of a veterinarian? *Does your dog have any areas of his/her body that are sensitive to touch or does not like touched? *What areas of his/her body does he like to have touched? *Is your dog on any medications? If so, what? *Has your dog ever had surgery? *Is your dog overweight? How much do the weigh? *Is your dog up to date on vaccines including heart worm prevention? *Training and EnrichmentHave you ever attended any training classes with your dog? If so, please list all classes, training facilities, and training methods: *Have you ever worked privately with a trainer? If so, please list trainers' names and training methods? *What "obedience commands" does your dog know? *What do you and your dog do for play? How often? *How would you describe your dog's energy level? *Describe your dog's energy level in relation to yours? *ExerciseWhat form of exercise does your dog receive? *How often? *Where does most of this exercise take place? *CarHow does your dog behave in a car? *Does your dog use a crate in the car? *Does your dog react (bark, growl, lunge at windows} in the car to any stimuli? If so, describe: *EmotionalHow many hours a day does your dog sleep? *Where does he/she sleep at night? *Is your dog in a crate any time throughout the day? *Do you confine your dog when you are gone or at any time? *Is your dog able to look out your windows? *Are your shades open or closed when you are gone? *Do you have a busy, active, noisy household? *Do you have a quiet household? *How many are in your household? (Please list each member of household and their age) *Do you have many visitors, either family, friends, or children at your house on a regular basis? *Do any members of your family have difficulty with your dog? (i.e. is there someone in the house that does not like your dog or who the dog is afraid of?) *What members of the family are involved with your dog in regards to feeding, training, disciplining? *How many hours per day on average is your dog home alone? *Do you have a fenced yard? If so what type of fence do you have? *Behavior ProfileWhat problems are you having with your dog's behavior? *When did you first notice this problem? *What have you done to solve this problem (if anything)? *How would you describe your dog's behavior? *In your mind, what is your dog's biggest problem? *Does your dog pull on leash when walking? *Has your dog ever bitten a person or another animal? *Are there people in the family that your dog has shown signs of fear or aggression toward? *Instructions How does your dog react to the following using a 0 – 5 scale. (0= No reaction; 1 = slight reaction; 2 = mild reaction: body tensing; 3 = moderate reaction:– body tense, vocalizing; 4= severe reaction: lunging, growling, barking; 5= bites or has bitten in response).Men *How does your dog react to the following: using a 0 - 5 scale?Women *How does your dog react to the following using a 0 – 5 scale?Elderly - canes? Wheelchairs? *How does your dog react to the following using a 0 – 5 scale?Children *How does your dog react to the following using a 0 – 5 scale?Other dogs *How does your dog react to the following using a 0 – 5 scale?Squirrels, rabbits, birds *How does your dog react to the following using a 0 – 5 scale?Cats *How does your dog react to the following using a 0 – 5 scale?Mail truck *How does your dog react to the following using a 0 – 5 scale?School bus *How does your dog react to the following using a 0 – 5 scale?Motorcycles *How does your dog react to the following using a 0 – 5 scale?UPS Truck *How does your dog react to the following using a 0 – 5 scale?Other (please provide details) Rules and liabilityI have read and agree to the terms included in the Canine Karma Liability form and Class Rules *Sign your first and last nameBefore continuing, please copy and paste the link below and read the Liability Agreement, Class Rules, and Responsible Dog Owner's Pledge https://www.caninekarma.org/newsite/wp-content/uploads/2019/02/Star-Forms-1.pdfOnce you have submitted this form, go back to the Class page and purchase the class on our website. 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