Zippity Do Dog Behavioral Intake Form

  • Zippity Do Dog Behavioral Intake Form

    for over-reactive dogs and dogs that struggle with other behavioral issues such as stranger-danger, resource guarding as well as fear-based anxiety

  • Please Read Entirely

    You are about to complete an detailed intake form, before you begin please confirm that you are in my service area:

    Attleboro, Attleboro Falls, Berkley, Dighton, Easton, Foxboro, Mansfield, North Attleboro, North Dighton, North Easton, Norton, South Easton, North Attleboro, Plainville, Raynham, Rehoboth, Sharon, Taunton. 

    If you do not see your community listed here, please reach out to me before completing this form, I am often able to make accomodations.

    Details

    • Please understand that consultations are a limited opportunity. By chosing a date to meet and submitting payment, you are taking away and opportunity from someone else who may be in a desperate situation, therefore the consultation fee of $195.00 is non-refundable. No exceptions. If you need to reschedule, no problem. You will have 90 days from the date of this form submission to use your credit.
    • This form is for one dog (exception is fighting between two dogs within the same household)
    • This consultation will take place in your home.
    • In most cases I do not need to see the behavior that your dog is struggling with, chances are I have seen it many times before with other dogs. I prefer to not upset your dog by putting them in a situation that is going to cause them stress and anxiety. The purpose of this intake form is to gather details and then during our meeting I will gather additional information.
    • Do not skip questions. Answer with an NA if it doesn't apply to you.
    • Be thoroughly honest in your answers. This is a judgement free zone.
    • You will receive a comprehensive follow-up report that outlines the why of your dog's behavior, that includes my recommendations and a training plan.
    • A consultation is not a remedy or replacement for behavioral training.

    I look forward to meeting with you and your dog.

  • Format: (000) 000-0000.
  • What is the best way to reach you quickly?
  • Do you use a crate for this dog?
  • How much time does your dog spend alone:
  • Is your dog allowed on furniture?
  • Is your dog social with unfamiliar people?
  • Has your dog ever bitten anyone? Please be honest. If your dog has bitten that doesn't mean I won't work with them.
  • Does your dog appear sensitive to sounds in the environment, causing behavioral responses (running to hide, shaking, howling, etc.)
  • Is your dog motivated by food/treats?
  • Is your dog motivated by toys?
  • How is your dog fed?
  • Do you currently have any of the following for your dog? (check all that apply)
  • Would you be interested in an enrichment plan for your dog?
  • What equipment do your use to walk your dog?
  • Has your dog ever worn an Electronic Collar?
  • How do you reinforce desirable behaviors?
  • How do you address undersireable behaviors? (jumping, barking, etc.)
  • Have you noticed any of the below? Check all that apply (look over your dog now)
  • Has your dog had previous training?
  • Please select any skills that your dog currently has that are 90% reliable across all settings in the presence of distractions. (Example: Stay in a sit, down or leave-it position while you leave the room and disapear from sight, or remain sitting outside while children run around them)
  • Thinking about the issues that have brought you here today, what was the previous treatment sought for the these issues?
  • Please select any methodology used to address any behavioral issues that your dog has experienced.
  • Thinking about any other areas of concern that you would like to discuss with the trainer:

  • When I look at a dog and see their limitations, I remind myself that they can be given the opportunity to shine in whatever ways they have the potential for shining. It might not look like another dog's glow, but that does not matter. Keep an eye out for the sparkle. It's there."-Debbie Jacobs

  • Date*
     / /

  • Consultation Payment *

    prevnext( X )
    USD
  • Should be Empty: