New Client Form Step 1 of 3 33% Name First Last Address Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEnter the telephone number at which you are most easily reached.Second phoneEnter a number you may be reached at if your primary number does not work.Email Enter Email Confirm Email What First Friends services are you interested in? One-on-One Training Group Classes Presentations Section BreakNames and ages of adults in your householdNames and ages of children in your householdNames, ages, and breeds (if known) of dogs in your householdNames, ages, and species of other pets that move about your householdExpected Changes in Household (arriving, leaving, or other)Do you expect any people or animals in the household to arrive or leave in the next few months? Or do you expect major changes in the living situation (for example, a move)? Please explain.What (if any) training have you done with your dog?Most recent vet visit and results: Primary Behavior Issue(s):What issues or behaviors are you looking for help with?Manners Basic skills Recall Leash Walking Behavioral concerns Barking Destructive Third Choice House Soiling Impulse Control Separation Anxiety Movement Sensitivity/Prey Drive Resource Guarding Handling Fearful of Strangers Household or family Other pets Reactive toward(barking/growling/snapping) Dogs – on leash Dogs – off leash Cats Unknown people/strangers Household or family Other Baby Preparation New Puppy New Dog Assistance finding a new dog Assistance re-homing a pet Onset of issue:*When did this problem first begin?Has your dog ever bitten anyone?YesNoWas the bite to a person or another dog?* Person Dog Other pet No bite history Was medical or veterinary care required?* Yes No No bite history What else would you like to tell me about your dog’s situation?CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.
