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  • Mindful Methods Info Form

    PLEASE READ BEFORE STARTING: Please allow yourself about 20-30 minutes to complete this info sheet. You will be able to save and continue your progress later if needed, which is located in the last section of the form. If you have more than one companion you are seeking training for, we will need an info sheet for EACH dog so we can assess needs individually. All of our forms and training plans can be shared (at your discretion) with veterinary providers as a means to centralize your issues and advocate for your companion more effectively! Please be as thorough as possible. You can never provide too much info! Our info form is thorough but helps to cut down on time spent asking you these questions in person so that we can spend more time training! Our goal is to address your needs to the best of our capabilities, while remaining objective in the process. Knowing past history and current behaviors will help us to guide you towards the most appropriate training plan, while helping to improve the relationship between you and your companion. We appreciate your patience and understanding. We look forward to working with you more!

  • Dog's Name:* Sex:*   
    Dog's current age:**   
    Age when you brought them home: **    
    Breed:*  Weight:*  Spayed/Neutered?*
    How old when spayed/neutered, if applicable?   *          
    Where did you get your dog from?    *      

    • General Wellness & Habits 

    • General Wellness & Habits

      Knowing your companion's wellness history can give us a better understanding of your challenges and if any of these issues could be contributing to frustration, reactivity, fear or place any physical/social limits on your companion.

    • Ingestion & hydration

      Brand of food:   *   
      Main protein (e.g.: chicken/salmon/beef-based):   
      Length of time on this brand:   *   
      Amount of food per meal:   *   
      Frequency (e.g.: twice per day):*   
      Method of delivery (e.g.: bowl, slow feeder, puzzles):   *   
      Does your dog graze or refuse meals totally or partially (check ALL that apply)?   *         
      Any dietary restrictions? (e.g.: cheese/dairy, certain treats, certain proteins)  *   
      Is your dog gassy after meals?                  *            
      Do you have any concerns over your dog's water intake?      *   
      Have you noticed any recent changes in hunger or thirst?      *      
      Please use this space to elaborate on any of the above questions with your comments/concerns:      

    • Pottying habits

      Take a look at the Purina Fecal Chart and answer the following questions:

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    • Typical fecal score (check ALL that apply):                     *                  
      How many times per day does your dog have a bowel movement?   * 
      Does your dog ever have accidents in the house?            *        
      If yes, how often and under what circumstances?                               
      Comments/concerns:      

    • Confinement and Separation 

    • Confinement and Separation

    • STOP: General separation distress looks different than clinical-level separation anxiety. Many coping mechanisms exhibited by dogs experiencing clinical-level separation anxiety are a risk to their personal safety. Signs of clinical-level separation anxiety include urinating/defecating when alone, excessive drooling, persistent howling/barking, chewing/digging/destruction, attempting to escape, pacing/inability to settle and coprophagia while alone (consuming feces). If you are unsure whether or not your dog qualifies, please complete the rest of the info sheet as honestly and thoroughly as possible.

       

      Only trainers with a CSAT-level certification can work with clinical-level separation anxiety in our program. If we feel your dog qualifies for individual focus from a specialty trainer, we will let you know after reviewing your intake sheet. We do not recommend drop-off training programs for dogs with clinical-level separation anxiety.

    • Even if you no longer confine your dog, please answer these questions as they pertained in the past.

      In what situations do you use confinement?   *   
      How does your dog respond to being confined during the day?   *   
      How does your dog respond to being confined at night?*   
      Where is your confinement located? *  
      Does your dog ever try to escape the confinement area?   *

    • How many hours is your dog typically left alone?
      *   
      Have you ever found drool on your dog's chest or in any confinement area when you come home?   *      
      Has it ever been brought to your attention by your neighbors that your dog is barking when you are not home?   * 
      Is your dog ever destructive when you are not home?* 
      Do you provide enrichment/treats when you leave?
         
      *   
      Does your dog have accidents when you are not home?   *   
      Do you have a petcam or other technology that allows you to view your dog's behavior remotely?   *         

    • Training and Routines 

    • Training and Routines

    • How often?   *   
      Name of the business?   *

    • Do you use a harness?   *   
      What type of collar do you use?
      *
      What type of leash do you use? *

    • General Behavior 

    • General Behavior

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    • Bite history (and attempts)

       

      Air snaps, muzzle punching, and "nips" all qualify and need to be reported to our trainers. Take a look at the graphic below with Cara Shannon's bite scale for dog-human and dog-dog bite scales for clarification:

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    • Incident 1 - type NA for anything that does not apply

      How long ago did the incident occur?   *   
      Who was the target? If a child is involved, age of child is helpful:   *  
      Where were you when the incident occurred?    *   
      Was the incident reported?   *   
      What area of the body did your dog bite, if applicable?   *   
      How severe was the bite, if applicable?   *   
      Was medical attention required?   *   
      Was a 10-day rabies hold required?   *   
      Who else was present when the incident happened?  *
      What took place right BEFORE the incident? In other words, what do you feel may have contributed?   *   
      How did you respond or interrupt the behavior?   *   
      What happened immediately after? This is a good time to list if there is anything you feel we should know about your dog's demeanor in the following minutes, hours, days:   *   
      To the best of your knowledge, were there ANY other changes around this time in health, diet, appetite, training, routines and if so, what?   * 

      Do you have another bite to report?        *   

    • Incident 2 - type NA for anything that does not apply

      How long ago did the incident occur?   *   
      Who was the target? If a child is involved, age of child is helpful:   *  
      Where were you when the incident occurred?    *   
      Was the bite reported?   *   
      What area of the body did your dog bite?   *   
      How severe was the bite, if applicable?   *   
      Was medical attention required?   *   
      Was a 10-day rabies hold required?   *   
      Who else was present when the incident happened?  *
      What took place right BEFORE the incident? In other words, what do you feel may have contributed?   *   
      How did you respond or interrupt the behavior?   *   
      What happened immediately after? This is a good time to list if there is anything you feel we should know about your dog's demeanor in the following minutes, hours, days:   *   
      To the best of your knowledge, were there ANY other changes around this time in health, diet, appetite, training, routines and if so, what?   * 

      Do you have another bite to report?        *   

    • Incident 3 - type NA for anything that does not apply

      How long ago did the incident occur?   *   
      Who was the target? If a child is involved, age of child is helpful:   *  
      Where were you when the incident occurred?    *   
      Was the incident reported?   *   
      What area of the body did your dog bite, if applicable?   *   
      How severe was the bite, if applicable?   *   
      Was medical attention required?   *   
      Was a 10-day rabies hold required?   *   
      Who else was present when the incident happened?  *
      What took place right BEFORE the incident? In other words, what do you feel may have contributed?   *   
      How did you respond or interrupt the behavior?   *   
      What happened immediately after? This is a good time to list if there is anything you feel we should know about your dog's demeanor in the following minutes, hours, days:   *   
      To the best of your knowledge, were there ANY other changes around this time in health, diet, appetite, training, routines and if so, what?   * 

      If you have additional incidents to report, please email them to us with the above details at info@mindfulmethodstraining.com

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    • What behaviors does the dog display when guarding (e.g. stiffens, whale eye, growls, blocks resource, moves away with item, lunges, air snaps, bites, etc.)?   *   

      What are you currently doing to address the guarding when it happens/what is your response?   *   

      What types of management do you employ, if any, to avoid guarding:   *   

      Please give us details about the guarding and anything else you think we should know. Helpful things to know are what types of toys/bones/items/areas are guarded, is the guarding against someone specific in the house, any trends you notice such as time of day, etc. The more thorough you can be, the more we can ensure the safety of all parties.*

    • Behavior Goals 

    • Behavior Goals

      Knowing your behavior goals is extremely helpful and can give us insight to other struggles not mentioned on the info sheet.
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    • Consider the chart above and where your dog is currently at in skillset with regards to what can be accomplished in a single session or training package. Please realize that advanced goals in the "PhD" level will require follow-up sessions, practice at your home, or may potentially not be possible for the individual learner. Feel free to visit our FREE resource on training expectations to help you understand what we may be looking for.

      TOP 5 SHORT-TERM GOALS - use the spaces below to tell us your TOP 5 goals and what you hope can be accomplished with our program. Please be specific about WHAT behavior you want to address (ie: no jumping, no mouthing, recall) and do not tell us "PhD level behaviors" - it is too vague:

      1.   *  
      2.   *   
      3.   *   
      4.   *   
      5.   *

    • Emotional Wellness 

    • Emotional Wellness

      This section is about YOU! Understanding your stress level helps our trainers calibrate training plans and communication. This section is not required, but you are encouraged to complete it.
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    • Thank you for your time and patience in helping us to understand your issues more thoroughly. We will reach out to you after we have reviewed your information.

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