Ume Mama Animal Behavior
Training and Consulting
How did you hear about me?
Name
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First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address:
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Owner Contact Number
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Area Code
Phone Number
Dog Name :
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Breed:
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Submit a photo of your dog
Date of birth (guess if rescue)
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Month
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Day
Year
Is your dog spayed/neutered and how old were they when surgery was performed?
Vaccinations up to date?
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Please Select
Yes
No
Is your dog on any medications or supplements?
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Cues are things you ask your dog to do, for example a sit or down. What cues does your dog respond to?
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How does your dog react to strangers?
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How does your dog react to other dogs?
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Has your dog ever bitten a person? A bite could be considered as teeth making contact with skin.
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Has your dog ever air snapped at a person? For example, your dog snaps their mouth in the air as if to bite.
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Does your dog guard resources? If so, please describe from whom, what resources your dog has guarded in the past, what your dog did exactly that made you believe they were guarding resources, and what you do in response to the resource guarding.
List three things about your dog that you love. Be sure to describe behaviors, so if your dog is "affectionate" what does that behavior look like?
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What are your top 3 training goals?
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Goal 1
Goal 2
Goal 3
Does your dog have any food allergies?
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Any other detail I should know about your dog?
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How well does your dog go with the flow if something unexpected happens such as: a sudden change of plans, sudden change in the environment, a transition between two activities.
How does your dog interact with other dogs?
How quickly does your dog reach “the point of no return”? Is your dog a zero to sixty dog?
Specific Behavior Questions
If you have a new puppy or rescue, you may skip this if you don't know enough about your dog.
Describe in observable terms one behavior your dog does that you would like to reduce. For example: "my dog barks for 3 minutes after someone knocks on the door"
Does the problem behavior immediately follow a demand or request?
What is the most immediate predictor of the behavior? For example, what happens immediately before your dog does the behavior.
What time of day does the behavior occur?
Where does this behavior occur? Physical setting, location, indoors/outdoors, a certain room, etc.
Setting events: Does the behavior occur when certain items or equipment are present, e.g., food bowls, leashes, toys, chews?
Setting events: Who is present when the behavior occurs? People, other dogs, specific people/animals?
Setting events: With whom is the problem behavior most likely to occur?
Setting events: Does the problem behavior occur during a specific activity?
When does the problem behavior NOT occur?
What has already been tried to change this behavior?
What would you like your dog to do instead? For example, if your dog is begging at the table maybe you want them to get into a down.
A little about you...
If we are meeting in-person: do your neighbors have dogs?
If yes, has your dog interacted with them?
If you have a yard, is it fenced?
How do you like to get feedback when learning?
in the moment
after I have tried something new
I don't like getting feedback
anyway is fine
What are 3 activities you like to do with your dog?
Did you grow up with dogs? If yes, did you ever witness any training done with family dog?
Could you identify and describe how you hope to feel at the end of the training session? For example: "I hope to feel more calm around my dog" or "I hope that my partner and I will be on the same page" or "I hope to learn more about dog behavior"
Is there anything else I should know about you that hasn't been asked here? For example, any allergies or disabilities that I should know to help our collaboration.
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