Ruff to Right Behaviour Modification Questionnaire

Your Name

First NameLast Name

Phone Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Please indicate if you prefer in-person or a virtual session

Pet's Name

First NameLast Name

Pet's Age

Ex: 2 years

Dog Breed/Mix

Ex: 2 years

Does your dog have any known medical conditions or special needs?If yes, please specify:

Where did you get your dog?

Ex: Shelter, Breeder

How long have you had your dog?

Ex: 3 months

How many people live in your household, what are their ages?.)

Do you have other animals in the home? If so, what types of animals are they, and what are their ages?)

What is the relationship like between your dog and the other animals?)

Describe the main behavioural issues you are experiencing (e.g., barking, chewing, reactivity, etc.)

When did you first notice these behaviours?

How often do these behaviours occur (e.g., daily, weekly, occasionally)??

Ex: 3 months

What triggers these behaviours (e.g., certain people, situations, other animals, noises, etc.)

Have there been any recent changes in your dog's life or environment that may have impacted their behaviour (e.g., moving, new pet, new baby, change in routine)?

What training methods have you tried so far? (e.g., treats, clicker training, training classes, professional help, etc.):?

How does your dog respond to training? (e.g., eager, distracted, fearful, frustrated, etc.):

What kind of rewards does your dog respond to best (e.g., treats, toys, praise)

Are there any other details you would like to share about your dog’s needs or your training goals?

Waiver and Release:

Assumption of Risk: I understand and acknowledge that participation in training sessions and behaviour modification programs involves inherent risks, including but not limited to accidental injury to myself, my dog, and others involved. I voluntarily accept these risks and agree to assume full responsibility for any damages or injuries that may occur.
Training Methodology: I acknowledge that the training methods used during the sessions are based on positive reinforcement and force-free techniques. I understand that I am responsible for following instructions and applying the training methods at home.
Health and Safety: I confirm that my dog is in good health and does not have any medical issues that could pose a risk to themselves or others. I agree to inform the trainer of any changes in my dog’s health or behaviour that may affect their participation in training.
Liability Release: I agree to release and hold harmless Erika Ehrenreich / Ruff to Right and its employees, agents, and affiliates from any liability, claims, or lawsuits that may arise from my participation in the training program or my dog’s behaviour during sessions.
Property and Equipment: I acknowledge that I am responsible for my dog’s equipment (e.g., collar, leash, harness) and for ensuring that it is in good condition. I will also ensure that my dog is properly secured while at the training location.
Behavioural Concerns: I understand that while training can greatly improve a dog’s behaviour, there is no guarantee of specific results. I agree to follow all provided instructions and to seek additional professional help if necessary.
Emergency Contact: In case of an emergency, I authorize Erika Ehrenreich / Ruff to Right to contact my veterinarian or seek immediate medical attention for my dog, if necessary, at my expense.
Agreement: By signing below, I confirm that I have read, understood, and agreed to the terms of this waiver. I understand that I am giving up certain legal rights by signing this form.

Signature

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