Email Intake Form
Which service are you interested in?
Private training
Remote video training
Board-and-train
Day Training
Puppy Right Start
What behavior issue(s) are you experiencing?
Aggression to familiar people
Aggression to strangers
Aggression to other pets
Aggression towards unknown/unfamiliar animals
Aggression around food/toys/space specifically
Aggression resulting in skin-breaking bites
Barking/growling/lunging ONLY on a leash or behind a fence
Destruction
Destruction or distress when left alone
Excessive barking
Fear/hiding/phobias
Potty training
Jumping/barking/mouthing
Other
Contact Information
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
SMS Agreement/Privacy Policy: By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging. Please write NO TEXTS below if you would NOT like to be contacted via text message.
Email
example@example.com
I prefer to be contacted via:
Email
Text/Whatsapp
Your Occupation:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What are the best days and times for our training sessions?
How did you hear about Kara/Canine Behavior Connection?
Google Search
Facebook
Referral from friend, rescue, trainer, vet (please list below so I can thank them!)
Other
Have you previously owned dogs? If yes, please briefly describe below.
Yes, I/we have owned dogs before
No, this is my/our first dog
One of us has owned dogs before, but this is the other's first dog
Other
Please briefly describe your previous dogs (breed, age when obtained, dates of ownership, behavior, anything else you feel is relevant).
(Optional) name of referral source
Basic Info About Your Pet
Pet's Name
Pet's Age
Where'd you get your pet? (Please provide the NAME and website of the rescue/breeder/shelter/store if possible).
How long have you had your pet?
What breed is your pet?
How much does your pet weight? Please indicate pounds or kilos.
What is your pet's sex (include neuter status)?
What is your pet's sex?
Neutered male
Spayed female
Intact male
Intact female
Other
Has your pet ever bitten/nipped or injured a person and/or animal? If yes, please describe below.
Yes
No
Other
Please describe any and all bite/nip incidents toward people and/or animals below:
What food does your dog eat? (Brand, kibble/canned/raw, quantity)
How many times per day (and when) do you currently feed your dog?
In what type of receptacle do you usually feed your dog (regular bowl, puzzle bowl, frozen kong, snuffle mat, etc.)?
Does your dog usually finish their food right away?
Are there any specific foods/treats your dog cannot have? If so, please list below.
Name, address, and phone number of pet's current Primary Care Vet Clinic/Veterinarian
When (approx) was your pet's last vet visit?
What was that vet visit for?
Please list ALL of your pet's medical diagnoses, approx date first diagnosed, and whether/how you're treating the condition (Examples: Arthritis in hips starting June 2021--treating w/glucosamine daily and rimadyl as needed; Elbow Dysplasia starting February 2023--not currently treating, just monitoring; ear infections starting February 2022--supposed to put ear drops daily but she won't usually let me)
Please list ALL medications and supplements your pet(s) take, even if they are only given sometimes. Please list the NAME and DOSAGE AMOUNT/FREQUENCY of the medication. (Examples: Fish Oil Capsule-180 mg EPA & 120 mg DHA twice daily, 100 mg Trazodone for fireworks/thunderstorms, Cyclosporine 0.2% Eye Drops-one drop once daily in L eye, Heartgard-272 mg ivermectin & 227 mg pyrantel once monthly, Carprofen 75 mg given as needed, usually a couple times monthly).
What equipment do you currently use to walk or train your pet? (Examples: front-clip harness, retractable leash, prong collar, long line, head halter, slip lead, clicker, treats, etc.)
Please describe your pet's daily routine. Include what exercise (s)he gets and what (s)he does while you're at work.
Are you considering giving up your pet because of this behavior issue?
Yes
No
Unsure
Please list ALL other pets (and frequently visiting animals) in household--include name, species, breed, and age. (Example: Simba, dog, Cane Corso, 4 years; Felix, cat, DSH, 13 years)
Please list ALL people who live in the household--include name, pronouns (optional), age/life stage and any other information you feel is unique/relevant to the situation. Include how often they are at the home if they do no reside there full-time. (Example: Roxanne, she/her, young adult)
Information on the Behavior Issue(s)
If you had to pick ONE issue to address, which would it be?
Please describe the behavior problem in more detail. What's going on?
What makes the behavior start? What makes it stop? Can you stop it? If so, how?
Are there any recent changes in the household that could be related to this problem?
Move
Divorce or separation
Family vacation
Visitors/guests
New baby
New pet
New job or schedule change
Other
How long has this problem been going on?
Is the behavior problem getting better, getting worse, or staying the same?
What, if anything, have you tried so far to help the behavior problem? What were the results?
Has your dog had any previous training (either in a class or on your own)?
Yes
No
If your dog is trained, what cues does (s)he respond to? Examples: sit, down, stay, shake?
Have you ever worked with a professional dog trainer (either with your current pet or a pervious one)? If you feel comfortable, please list the name(s) of the trainer(s)/business(es) you worked with.
If you have worked with a previous dog trainer, what did you and your dog learn? For how long did you work with this trainer? (Example: My dog learned to stay on a raised bed with distractions, to do "watch me" and come when called. I did 3 private sessions with the trainer spread over 2 months.)
If you have worked with other dog trainer(s) with your current pet, do you give me permission to contact them for training records?
What are your goals going forward with your pet?
What is your timeframe for fixing this problem? Example: I would like to have this fixed before Christmas due to family visiting.
How many minutes per day and days per week can you put into training?
Is there anything else I should know? Any other behaviors that are concerning to you/"driving you nuts?"
Submit
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