Intake Form
Use the "Save" button below if you wish to save your progress and continue this form later.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
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
State
Zip Code
Dog's name
*
Dog's age
*
Dog's breed
*
Dog's sex
*
Female (Spayed)
Female (Unspayed)
Male (Neutered)
Male (Unneutered)
Dog's weight (approx)
*
(Optional) Share a favorite picture of your dog with us:
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How long have you owned your dog?
*
< 1 week
2-4 weeks
1-2 months
3-4 months
5-6 months
6 months-1 year
1-2 years
2-3 years
3-4 years
5-6 years
7+ years
Where was your dog acquired from?
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Breeder
Shelter
Rescue group
Pet Store
Online
From a friend or relative
Other
List all members of the dog's household and indicate whether they are a child, adult, or other pet (what kind?).
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Primary veterinarian and hospital name:
May we send a copy of your dog's behavior report and training plans to your veterinarian?
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Yes
No
List any food allergies, dietary restrictions, or other relevant health conditions:
What are your dog's favorite treats, toys, or activities?
What type of exercise or enrichment activities does your dog typically get and when?
What is one thing you most enjoy about your dog?
If relevant, please share any helpful info for our visit, such as visitor parking info, gate codes, etc.:
How did you hear about us?
*
Training & Behavior Information
In detail, please describe your training goals and behavior concerns that you'd like to address:
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Please be specific. i.e. What does the behavior look like? When and how often does it occur? What makes it better or worse? Has it changed over time?
Has your dog ever shown aggressive behavior (growled, snarled, bitten or attempted to bite)?
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Yes
No
Has your dog ever bitten a person or other animal which broke skin?
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Yes
No
For each incident: Describe who it was directed at, the situation preceding the aggression, and describe if anyone was injured (and how severely):
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Which of the following threat behaviors, which often precede a snap or bite, have you seen from your dog? (Check all that apply)
Freeze
Hard, tense stare (whites of eyes showing)
Eats food or chews object more quickly/intensely
Growl
Snarl (bared teeth)
Snap (attempted bite that misses)
What equipment or tools do you currently use to train or manage your dog, if any?
*
Ex: Walking harness, head halter, special collars, treats, invisible fence, or other devices.
What equipment or tools do you currently use to train or manage your dog, if any?
Ex: Harness, training collar, treats, invisible fence, or other devices.
How would you describe your dog's general interest in food/treats?
Highly food-motivated
Somewhat food-motivated
Not very food-motivated
Is your dog comfortable being left home alone?
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Yes
No
Please explain how your dog reacts as you are preparing to leave, and what your dog does when alone:
*
COVID-19 Information
Have you or any member of your household tested positive for COVID-19 within the last two weeks?
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Yes
No
Explain who was exposed and when:
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I agree that I must notify Collaborative Canines if myself or someone in my household tests positive for the virus, at any time prior to the appointment.
*
I have read and agree to the terms above.
Guarantee Policy
Collaborative Canines cannot guarantee any particular training outcomes, performance, or results. I understand and accept that even the most effective dog training practices function only to increase or decrease the probability of a certain behavior or behavioral outcome.
*
I have read and agree to the terms above.
Photo & Social Media Consent
I agree that pictures and/or videos of me, my family members, and/or my dog may be posted to the Collaborative Canines website, public social media pages such as Facebook, Instagram, and YouTube, or used in other promotional materials.
*
I have read and agree to the terms above.
I agree that pictures and/or videos of me, my family members, and/or my dog may be posted to the Collaborative Canines website, public social media pages such as Facebook, Instagram, and YouTube, or used in other promotional materials.
*
I have read and agree to the terms above
Yes, dog photos are okay to share, but please exclude photos/videos of human family members
No, please do not share photos my dog
Cancellations & Rescheduling Policies
Cancellations: You may cancel up until 48 hours before the appointment to receive a refund of 50% of the session cost. Appointments cancelled later than that will not be refunded. Rescheduling: You may reschedule at no charge up until 48 hours before the appointment time. Rescheduling with less than 48 hours notice given will result in a rescheduling fee of 50% of the session cost.
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I have read and agree to the terms above.
Waiver of Liability
Collaborative Canines will endeavor to offer only sound, safe, and responsible training instructions and recommendations. However, I recognize that Collaborative Canines is not responsible for any unintentional errors, omissions, or incorrect assertions. I understand that the recommendation of any other product or service is not a guarantee of my satisfaction with that product or service. Further, I am and will remain responsible for the actions of my dog at all times. I assume responsibility for any injury, expense, costs, or damages caused by the actions of my dog that occur during training or after training is completed. I hereby agree to indemnify and hold harmless Collaborative Canines of any and all claims by myself or claims by any member of my family of injury, expense, costs or damages to myself, my dog, or to any third parties arising out of my own actions or the actions of my dog at any time. I have read the above-stated provisions, and I agree to accept those responsibilities.
*
I have read and agree to the terms above.
By signing below, you indicate that you have read and agree to the policies and waivers as stated above, and that the provided information is true and accurate to the best of your knowledge.
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