Let’s do this.Ready to get started on your dog behavior journey? Help us make the most of your time with us by answering the questions below. Your Information Name * First Name Last Name Pronouns Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Number of people living in your home * Please list the age(s) of anyone under the age of 18 living in your home Your Dog's Information Dog's name * Dog's Age * Estimates are okay! Dog's weight * Estimates are okay! Dog's gender and spay/neuter status * Intact Female Spayed Female Intact Male Neutered Male What is your dog's Breed or breed mix? * Please write "Mixed" for mixed breed dogs who have not received a dna test. Where did you get your dog? * Breeder Shelter or Rescue Friend or Family member Found Accidental Litter Online Group of Marketplace (ie. craigslist, facebook) Other How long have you had your dog? * What does your dog eat? * How many minutes of daily exercise does your dog receive on an average day? * Where does your dog spend the majority of their time? * Do you have other pets? If so, please list species, age, and spay/neuter status. Do you wish to seek behavioral help for other pets in your household? Has your dog visited the vet within the last year? * Yes No Does your dog have any current or previous medical concerns? * Yes, currently Yes, previously No Please list any food allergies your dog has Behavior Assessment Please describe any previous training your dog has had * In 2-3 sentences, please describe your reason for seeking training. * How concerned are you regarding your dog's current behavior? * Please rate on a scale of 1-5. 1- Not concerned 2- Mildly concerned 3- Somewhat concerned 4- Moderately Concerned 5- Extremely concerned Are you considering rehoming, behavioral euthanasia, or surrendering to a shelter? * Yes No I'm not sure Does your dog experience any of the following? * The following is for pain screening purposes. Please select all that apply. Avoidance of equipment ie. harness or collar Frequent vocalizations "Fly snapping" Agitation or "bad moods" Disinterest in exercise Dislike of riding in vehicles Lack of appetite Scratching, biting or licking self "no-touch zones" Head shaking Aggression when handled Restlessness None of the above Please describe any significant events in your dog's history such as dog fights or bites involving a person or other animal Leave blank if your dog has not experienced any significant events Behavioral Survey Please select the option(s) that most closely represent your dog's behavior in the following circumstances. With members of the household, my dog is: * Social and Friendly Aloof and Unbothered Fearful and Avoidant Reactive, Aggressive, or Defensive Unknown/ Unsure When seeing other dogs on walks * Social and Friendly Aloof and Unbothered Fearful and Avoidant Reactive, Aggressive, or Defensive Unknown/ Unsure When a stranger approaches on a walk, my dog is: * Social and Friendly Aloof and Unbothered Fearful and Avoidant Reactive, Aggressive, or Defensive Unknown/ Unsure When a stranger comes inside, my dog is: * Social and Friendly Aloof and Unbothered Fearful and Avoidant Reactive, Aggressive, or Defensive Unknown/ Unsure When getting his/her nails trimmed or ears cleaned, my dog is: * Social and Friendly Aloof and Unbothered Fearful and Avoidant Reactive, Aggressive, or Defensive Unknown/ Unsure When hearing an unfamiliar noise, my dog is: * Social and Friendly Aloof and Unbothered Fearful and Avoidant Reactive, Aggressive, or Defensive Unknown/ Unsure When seeing an unfamiliar object, my dog is: * Social and Friendly Aloof and Unbothered Fearful and Avoidant Reactive, Aggressive, or Defensive Unknown/ Unsure Is there anything else you'd like to share? Electronic Signature * By typing your name below, you acknowledge that you have read and agree to the terms & conditions of the service agreement found at caninesandcaregivers.com/service-agreement First Name Last Name Thank you! We are looking forward to meeting you and discussing your needs at your 15-minute complimentary call. Haven’t booked yet? Book your appointment, then refer to the information below regarding next steps:What’s Next?- Prior to your call, you will receive a link for Google Meet. If you have never used Google Meet, set aside time prior to your call to make sure you meet the requirements.-
