K9 Learning Solutions, LLC
Behavior & Training Consultation Intake Packet
Nicole Gianotto, VSA-CDT
Certified Professional Dog Trainer & Canine Behavior Consultant
Columbus, New Jersey | 609-819-6828 | www.k9learningsolutions.org
This intake packet supports a comprehensive and safe behavior evaluation. Please provide detailed responses to ensure accurate assessment and planning.
Client Information
Owner Name(s):
Address:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Preferred Contact Method: Call / Text / Email
How did you hear about K9 Learning Solutions?
Dog Profile
Dog's Name:
Breed/Mix:
Age:
Sex: M / F Spayed/Neutered: Yes / No
How long have you owned this dog?
Comments
Other animals in household (species/age/temperament):
Daily Structure & Management
Wake-up Time:
Feeding Times:
Exercise Routine:
Training Sessions:
Alone Time (hours/day):
Sleep Location: Crate / Bed / Free roam
When home alone: Crated / Gated / One room / Full access
History of destruction when alone? Yes / No If yes, describe:
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Training History & Cue Fluency
Previous training? Yes / No If yes, describe type and trainer:
Methods used:
Positive reinforcement
Balanced
E-collar
Prong
Board & Train
Tools used:
Flat collar
Martingale
Harness
Head halter
Long line
Other
Cues performed reliably (=80% low distraction):
Cues known but inconsistent:
Reliable in which environments?
Home
Yard
Outdoors
Around dogs
Around people
Marker system used:
Verbal marker
Clicker
None
Primary Behavior Concerns
1.
2.
3.
When did behaviors begin?
Frequency:
Describe behavior (body language, intensity, duration):
Has behavior escalated, improved, or remained stable?
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Resource Guarding & Possession Behavior
Guarding observed around:
Food
Toys
Furniture
Sleeping spaces
People
Animals
Behavior observed:
Freezing
Stiffening
Growling
Snapping
Biting
Avoidance
Most recent incident:
Allows safe removal of items?
Yes
No
Inconsistent
Diet & Feeding Structure
Current diet (brand/type):
Time on current diet:
Feeding schedule:
Free-fed
One meal
Two meals
Three meals per day
Feeding location:
Fed near other animals?
Yes
No
Observed feeding behaviors:
Eats rapidly
Guards bowl
Refuses when stressed
GI upset
Reactivity, Anxiety & Arousal
Reacts to:
Dogs
People
Children
Visitors
Noises
Vehicles
Wildlife
Handling
Reaction type:
Barking
Lunging
Growling
Snapping
Freezing
Shutdown
Bite history?
Yes
No
If yes, describe context and severity:
Startles easily?
Yes
No
Recovery time: Immediate
Minutes
Extended
Veterinary & Medical History
Primary Veterinarian & Clinic:
Last full exam date:
-
Month
-
Day
Year
Date
Diagnostic testing performed:
Bloodwork
Thyroid
X-rays
Pain assessment
None
Medical diagnoses (past or present):
Current medications/supplements (include dosage):
Behavior discussed with veterinarian?
Yes
No
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Behavior Consultation Package & Investment
One–90 Minute Training / Behavioral Evaluation
Two–60 Minute In-Person Training Sessions
Two–20 Minute Zoom Follow-Up Sessions
Scheduled Calls and Ongoing Support to Guide Implementation of Training Plan
Additional training sessions may be added if requested or professionally recommended.
Payment Terms
Payment is due at the time of the initial training and behavioral evaluation session. Accepted forms of payment: Zelle, Venmo, cash, or check.
Hold Harmless, Liability & Full Disclosure Agreement
Participation in dog training and behavior modification involves inherent risks, particularly in cases involving reactivity, aggression, fear-based behaviors, or prior bite history. I am responsible for disclosing all known behavioral concerns and agree to maintain appropriate management and supervision. I agree to hold harmless and release Nicole Gianotto and K9 Learning Solutions, LLC from liability except in cases of gross negligence. No guarantees of specific outcomes are expressed or implied.
Owner Signature:
Printed Name:
Date:
-
Month
-
Day
Year
Date
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