Your Name
*
Email Address
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Telephone Number
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dogs name
*
Breed of Dog
*
Date of Birth
*
If DOB Unknown, use best estimate
What Prompted you to seek help?
General Obedience
Resource Guarding
Barking/Lunging at unfamiliar dogs
Barking/Lunging at unfamiliar people
On-leash reactivity
Off-leash reactivity
Impulse Control
Barking
Puppy Training
Socialisation
Has your dog completed their vaccinations?
Yes
No
If no to the above, is your dog a puppy under 12 weeks old?
Yes
No
Type of Assistance Preferred:
In-Person
Remote/Virtual
Combination
Description of your top challenge and when it first started
Has your dog ever bitten another dog?
Yes
No
Other than play biting, has your dog ever bitten a human?
Yes
No
If yes to above, please give as much detail as possible about the circumstances. If more than one incident, detail each time the bite(s) happened.
Please give details of any accessibility requirements you may have e.g. large print, printed media over video etc.
Additional Information that you feel is important for me to know:
Please tick the box to confirm you have read and accept our Terms & Conditions, attached to your welcome email.
Yes
Signature
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