Fields marked with an * are required HTML Please fill out the form below, so we can best serve your and your dogs’ needs. I am interested in one of the following: Private or semi-private coaching session Group class (currently drop-ins only) Trial and/or training video review via Zoom Hosting a small group coaching day/weekend - please provide more information in the “Additional Comments” section” Hosting a seminar (topic-specific powerpoint presentation with coaching) - please provide more information in the “Additional Comments” section” Hosting a topic-specific webinar - please provide more information in the “Additional Comments” section” Other (please elaborate): If other, please explain: Dog Owner Information Dog Owner Information Dog Owner's Full Name * Address * City * US States * - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Zip * Phone * Email * Physical Limitations * Do you have any physical limitations that we should be aware of (e. g. in wheelchair, arthritis in hands, etc.): Yes No Do you have any physical limitations that we should be aware of (e. g. in wheelchair, arthritis in hands, etc.): If yes, please elaborate (e. g. hard of hearing, arthritis in hands, difficulty bending over): Referred By: Veterinarian Shelter/rescue group Current or former HeRo client Other dog professional (e. g. groomer, boarding kennel, pet sitter, other trainer) Internet search Newspaper ad Brochure or business card Other Please provide us with additional information (e. g. name of vet, shelter, client, etc.): Dog Information Dog InformationIf you have multiple dogs you would like us to work with, please fill out one form per dog. Dog's Name * Age or Date of Birth * Gender * Male Female * Intact Neutered/Spayed Breed or Breed Mix * Is your dog current on current on vaccinations/titers? * * Yes No If no, please elaborate: Does your dog have any health issues or restrictions? * Yes No If yes, please elaborate (e. g. allergic to specific foods, hip dysplasia, blind, etc.): How long have you had your dog? Where did you get your dog from? Breeder Shelter or rescue group Stray Pet store Puppy mill Friend/co-worker Newspaper ad Other Please provide us with additional information (e. g. name and location of breeder, shelter, pet store, etc.) Describe your dog's daily activity level: Low Medium High Please list specific training issues or exercises that you would like us to address: Does your dog have any behavioral issues? * Yes No If yes, please check all that apply: Afraid of people Reactive/aggressive towards people My dog has bitten a person Reactive/aggressive towards other dogs My dog has bitten another dog Apprehensive in new environments Afraid of noises Guards food/toys or other objects Separation anxiety or distress Other If other, please elaborate: Service Policy Agreement * Yes I have read, understand and agree to the Service Policies Message * If you are a human seeing this field, please leave it empty.
