BEHAVIORAL INTAKE FORM

Welcome to Friendly K9

PERSONALIZED TO YOUR NEEDS
Assessment Form

This assessment form will allow for you to schedule a call to which will provide a free assesment over the phone. Thank you
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
NAME & BREED

NAMEBREED
AGE & SEX*

AGEMALE/FEMALE
HISTORY OF DOG
HEALTH CONCERNS

Difficulties with eatingDrinking a lot or to littleRapid BreatingVomitingChanges in stoolLethargicPoor balanaceWeeping or red eyesSkin sensitivityWhining or cryingAggression
ANY ADDITIONAL HEALTH CONCERNS*
HOUSE BEHAVIORS

PROTECTIVEJUMPINGNIPPINGPOSSESSION AGGRESSIONCOUNTER SURFINGBARKINGSEPERATION ANXIETYLACK OF STRUCTUREFOOD AGGRESSIONNOT POTTY TRAINEDNOT CRATE TRAINEDOVERSTIMULATEDDOOR REACTIVE (BARKING)
ANY ADDITIONAL HOUSE BEHAVIORS*
SOCIALIZATION

REACTIVE TO DOGSREACTIVE TO PEOPLEBARKINGNIPPINGWHININGCOWARDINGOVERSTIMULATED
ANY ADDITIONAL SOCIALIZED BEHAVIORS*
ENVIRONMENTAL BEHAVIORS

REACTIVE TO VEHICLESLOUD NOISESHEAVY TRAFFIC AREA'SBARKINGANXIETYAGGRESSIONOVERSTIMULATED
ANY ADDITIONAL ENVIRONMENTAL BEHAVIORS*
COMMANDS YOUR DOG NEEDS WORK ON

SITSTAYPLACEDOWNCOMEHEELOFFNO
BEHAVIORS ON THE LEASH

PULLINGBARKINGWHININGLUNGINGDOES'NT MOVEAGGRESSION
Where did you hear about us ?

BarkGoogleInstagramFacebookRescue/Veterinian
Schedule a call
When are you looking to proceed training ?

MonthDayYear
Date
Should be Empty:

Welcome to Friendly K9