Intake Form To get started, complete the intake form below. We reply to all submissions. If you haven’t heard back from us within a couple of days, please check your junk folder or reach out via email. Name * First Name Last Name Email * Mobile Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Dog Information Let's get some info about your furry friend. Dog's Name * Breed * Age * Sex * Female Male Neutered/Spayed? * Yes No Has your dog attended basic training? * Yes No A little Last vet visit? Please select the type of training methods that have been practiced with your dog * Positive Reinforcement: Food - toys - praise Punishment: Corrective Equipment or Alpha Based Training Mixed: Some Treats Some Correcting Training Commitment What are THREE goals you're hoping to achieve? * Which package interests you? * No charge will be made at this point. You can change your mind or ask questions when you speak with your trainer. Help! ASAP! - $200 Assessment & Support Sustainable Changes - $1000 Weekly Six Week Program Sustainable Changes Lite - $500 Bi Weekly 6 Week Program (for existing clients) In order for separation anxiety training to be effective, it’s important that we suspend/minimize absences (not leave the dog alone longer than they’re comfortable) for the duration of training. How do you feel about this? * That’s not possible for me I can make it work I don’t leave my dog alone now Please select the areas of concerns in which you are seeking support with Anxiety or stress when left alone Stress Being Separated Stress Being Confined Destructive Behaviours: chewing - barking - house training It's Complicated Relationship Building Does your dog have to be left home alone due to work, personal life, etc.? Yes No Rarely Often Is your dog currently on any medications/supplements? If yes, please describe. Does your dog have any ongoing health issues? If yes, please describe. Have you talked to your veterinarian about your dog’s behaviour? If so, what was the outcome of that conversation? How long has your dog had separation anxiety? What does your dog do when left alone? Pace Drool Destroy exit points (doors/windows) Bark/whine/howl Destroy other items Pant Urinate/defecate indoors Scratch at door I'm not sure Can your dog be left with others? Yes - happy/comfortable with friends/family/petsitters I've never tried No - in distress if away from primary caregiver/s Does your dog have any other fear, anxiety, aggression or reactivity issues? If yes, please describe. Does your dog bark, panic or startle at everyday noises (e.g. thunderstorms, fireworks, delivery people, sounds outside)? If yes, please describe. How long is your dog being left alone on a typical day? When left alone my dog is typically... Confined/in crate Free/loose in the home I've never left my dog alone Confined/in crate Anything else we should know? Don't be shy! Thank you!
