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Behavior Modification
Intake Form

Please complete the form below with as much detail as possible to help me understand your Behavior Change goals and current situation.

 

For Behavior Modification inquiries, please also fill in my Dog Training Intake Form.

 

Thank you!

(this form has 5 sections)

Basic Dog Pawrent Information

Behavioral History & Problem Behaviors

I understand these questions may seem numerous and occasionally repetitive. However, I encourage you to provide as much detail as possible, even if some information seems irrelevant now. The more thorough your answers, the better I can understand your dog’s behavior and assist you effectively!

Thank you!

What are the 3 main issues you experience with your pet in order of priority with Answer 1 being the main issue.

How would you describe the severity of the problem?
Mild
Moderate
Severe
How would you describe the frequency of the problem?
Rare
Often
Frequent
Other
Any noticeable change in severity?
Yes
No
Any noticeable change in frequency?
Yes
No
Have you considered euthanasia/rehoming your dog for this behavior?
No
Yes
Please subjectively rate your perception of the main behavior problem
Is your dog happy to be left alone?
Yes
No
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