Info Sheet

  • Mindful Methods Info Sheet

    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!
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  • 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:      

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    • 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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    • Image-199

    • 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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    • Save & Continue 

    • Saving your form allows you to come back later and complete it, but will require you to create an account with Jotform.

      Choose "next" to move on to our service agreement and submit your form.

  • Mindful Methods Companion Coaching, LLC Service Agreement

    Please provide accurate and complete answers. This form must be signed by a person who is 18 years or older.

  • Agreement for Training Services

    • I understand and agree that a 48-hour notice is required for cancellation in order to reschedule or receive money back. Failure to cancel more than 48 hours ahead of time may result in forfeiture of the session/cost of the service, as well as any travel fees paid ahead of time.
    • Support is available via phone, text, or email for 2 weeks following the completion of any service/package.
    • All resources and materials shared are the property of Mindful Methods Companion Coaching, LLC and are not authorized to be shared or duplicated.
    • Separation anxiety programs cover separation/isolation distress only. All other behavior issues require purchase of a separate package.
    • Service areas and travel fees:
      • A travel fee of $25 per session applies to all areas 16-25 miles outside of the trainer's travel radius.
      • Travel fees are due via cash at the time of arrival or ahead of time via Paypal, Venmo, or Zelle. No call/no shows result in forfeiture of travel fees.
    • By booking services, I confirm that I am in compliance with local and state laws regarding the vaccination of canines. All dogs 16 weeks or older need to be up-to-date on rabies vaccinations.
    • I understand and agree that Mindful Methods Companion Coaching, LLC will teach me how to teach my dog. I will be present for and participate in all scheduled training sessions.
    • I understand and agree that it is important for children to learn how to interact safely and effectively with their dog. If I have children, I will encourage them to participate in training so we can learn together. Children should be supervised by an adult during training and Mindful Methods Companion Coaching, LLC will not carry out private training sessions without a legal adult present.
    • I understand and agree that dogs learn through repetition. My dog and I will practice between scheduled training sessions to turn our new skills into new habits.
    • I understand and agree that Mindful Methods Companion Coaching, LLC uses positive reinforcement, also called reward-based training. We will use food, toys, attention, play, and other things my dog loves to reward or reinforce them.
    • I understand and agree that Mindful Methods Companion Coaching, LLC does not use punishment, corrections, or harsh equipment to scare, startle, intimidate, or force my dog. I agree not to use aversive tools while working with Mindful Methods Companion Coaching, LLC.
    • I understand and agree that every trainer has methods that they recommend or avoid. If I read or hear about other methods and want to try them, I will ask if they work within the philosophies held by Mindful Methods Companion Coaching, LLC.
    • I understand and agree that Mindful Methods Companion Coaching, LLC does not offer a guarantee of behavior outcome or change.
    • I understand and agree that Mindful Methods Companion Coaching, LLC is not a medical professional and cannot/will not advise as such.
    • I understand and agree that Mindful Methods Companion Coaching, LLC has the right to terminate my training package in accordance with cancellation and refund policies for not adhering to the Training Agreement.
       

    Refund Policies

    Private in-home training:

    • Sessions and packages are non-transferrable.
    • Refunds qualify for an administrative fee of the following:
      • 4-pack: $75 deducted off prices listed below.
      • 7-pack: $100 deducted off the prices listed below.
      • 12-pack: $150 deducted off the prices listed below.
    • 4-pack: canceling after the first session qualifies for a refund of $525, if the cancellation is received within 2 weeks of completion of the first session. No refunds if canceled after the second session. Administrative fees will be deducted off the total.
    • 7-pack: canceling after the first session qualifies for a refund of $1050. The remaining sessions are valued at $175 and refunds are available up until the third session, if the cancellation is received within 2 weeks of completion of the third session. No refunds for canceling after the fourth session. Administrative fees will be deducted off the total.
    • 12-pack: canceling after the first session qualifies for a refund of $1925. The remaining sessions are valued at $175 and refunds are available up until the fifth session, if the cancellation is received within 2 weeks of completion of the fifth session. No refunds for canceling after the sixth session. Administrative fees will be deducted off the total.
    • Sessions and packages expire four months after purchase. No refunds will be issued for packages past the expiry date.
    • If it were to be determined by the trainer that seeking the assistance of a different trainer is needed, then a refund will be issued for the remainder of any package that cannot be completed, and will not be subject to administrative fees.
       

    Separation Anxiety Training:

    • After the initial consultation, payment is due in full to reserve monthly services with the trainer.
    • Cancellation policy: non-refundable, non-transferrable. Being unable to adhere to the program structure at any point in time will result in forfeiture of the package, without refund. I am aware of the following:
      • Due to the nature of the program, packages include a mix of synchronous and asynchronous instruction and are intended to be completed weekly. Any discontinuation of the training will result in forfeiture of the package, without refund.
      • For the first 4 weeks, it is required that I be available and in town. After the initial 4 weeks, any extended absences (more than 2 days) should be discussed with the trainer as it will effect the training strategy.
      • This program requires suspending all panic-inducing absences (barring absence rehearsals) which may require employing dog sitters, dog daycare, or seeking assistance from friends, family, or neighbors.
      • Additional technology (and expenses) may be required in order to complete the package, such as access to virtual meeting platforms and security cameras to view the dog’s behavior during absence rehearsals.

     

    Day Training:

    • After the initial consultation, payment is due in full to reserve weekly services with the trainer.
    • Cancellation policy: non-refundable, non-transferrable. Any agreed upon refunds will be subject to a $150 administrative fee.
    • Sessions and packages expire four months after purchase. No refunds will be issued for packages past the expiry date.
    • If it were to be determined by the trainer that seeking the assistance of a different trainer is needed, then a refund will be issued for the remainder of any package that cannot be completed, and will not be subject to administrative fees.

     

    Waiver & Release of Liability

    • In consideration of the risk of injury while participating in dog training (the “Activity”), and as consideration for the right to participate in the Activity, I hereby, for myself or my minor child or ward, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge Mindful Methods Companion Coaching, LLC, located in Saint Charles, IL 60174, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity.
    • I am voluntarily participating in the aforementioned dog training activity entirely at my own risk. I am aware of the risks associated with participating in this activity, which may include, but are not limited to, physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and death. I understand that these injuries or outcomes may arise from my own or others’ negligence, conditions related to travel, or the condition of the activity location(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this activity, including travel to, from and during this activity.
    • I agree to indemnify and hold harmless Mindful Methods Companion Coaching, LLC, against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney’s fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf.
    • If Mindful Methods Companion Coaching, LLC incurs any of these types of expenses, I agree to reimburse Mindful Methods Companion Coaching, LLC. I acknowledge that Mindful Methods Companion Coaching, LLC, and their directors, officers, volunteers, representatives, and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Mindful Methods Companion Coaching, LLC.
    • I acknowledge that I have carefully read this “Waiver and Release” and fully understand that it is a release of liability. I expressly agree to release and discharge Mindful Methods Companion Coaching, LLC, and all of its affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, from any and all claims or causes of action and I agree to voluntarily give up or waive any right that I otherwise have to bring a legal action against Jessie Kasper and Mindful Methods Companion Coaching, LLC for personal injury or property damage.
    • To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part Mindful Methods Companion Coaching, LLC, its agents, and employees.
    • In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. In the event that any damage to equipment or facilities occurs as a result of my or my family’s willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness.
    • This Agreement was entered into at arm’s-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both myself and Mindful Methods Companion Coaching, LLC agree that this Agreement is clear and unambiguous as to its terms, and that no other evidence will be used or admitted to alter or explain the terms of this Agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into.
    • In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect, so long as the clause severed does not affect the intent of the parties. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.
    • This Agreement shall be governed and construed in accordance with the laws of the State of Illinois; and that disputes between the parties to this Agreement concerning the subject matter of this Agreement shall be submitted to arbitration for resolution or to the courts of Kane County, IL, at the discretion of Mindful Methods Companion Coaching, LLC.

  • Photo & Video Release

  • Body Cameras & Session Recordings

    Trainers may wear a body camera at all times that records audio and video of the environment and virtual sessions may be recorded with the following intent and restrictions:

    • A video/audio recording of the session may be provided to me for reference of concepts discussed. I understand that this is intended to help busy families whose schedules may not align with each other's or with the trainer's.
    • Provide objective feedback on body language and behavior to other professionals such as training mentors, primary veterinarians, and veterinary behaviorists. Should the need arise to share with third-party individuals, the trainer will ask permission before sharing.
    • To increase personal safety and reduce general liability for all parties involved. 
    • Body camera footage is not authorized by Mindful Methods Companion Coaching, LLC, for distribution outside of the immediate household members and is not authorized for resale in any manner. Body camera footage is the sole property of Mindful Methods Companion Coaching, LLC.
    • I may be provided with an invite/link to a personalized folder in Google Drive to view my recordings. Video recordings will be deleted after 30 days.
    • I understand that video and audio footage of my session(s) may not be guaranteed, as not all trainers participate or technological errors may occur.

  • Cell Phone Photos & Videos

    The trainer may take photos and short videos during the training session with a personal cell phone. These photos and videos may be used on social media or other promotional material. 

    The intent is to showcase the strengths of the dogs worked with and to celebrate the successes of both guardian and companion. Pets will never be showcased struggling with fear, reactivity, aggression, or any other behaviors that would shed them in poor light. It is the wish of Mindful Method Companion Coaching, LLC to encourage confidence and foster an environment of safety that is free of judgement. Generally, permission will be asked for again verbally during the session before taking any digital material on a cell phone.

    • I hereby grant and authorize Mindful Methods Companion Coaching, LLC, and all employees, the right to take, edit, alter, copy, exhibit, publish, distribute, and make use of any and all pictures or video taken of me, my minor child, or my pet dog or cat to be used in and/or for legally promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites, and other print and digital communications, without payment or any other consideration. This authorization extends to all languages, media, formats, and markets now known or hereafter devised. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing.
    • I understand and agree that these materials shall become property of Mindful Methods Companion Coaching, LLC, and will not be returned.
    • I hereby hold harmless and release Mindful Methods Companion Coaching, LLC and all employees, from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate. 
  • Clear

  • Please be patient when you hit submit and wait for the "thank you" page to pop up. If you do not receive an email notification that your submission was successful, neither did we. Please contact us ASAP if you do not receive an email.

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