Free 20‑Minute Behavior Phone Call

Free 20‑Minute Behavior Phone Call – Intake Form

This brief form helps me understand your dog’s situation and whether we’re a good fit to work together. The 20‑minute call is for initial triage, safety, and next‑step planning, not a full behavior consultation.
Section A – Client & Dog Info
Your full name*

First NameLast Name
Phone number (for the call)*
Please enter a valid phone number.
Email address*
example@example.com
City, state, ZIP*
Preferred pronouns
Dog’s name*
Dog’s age (or best estimate)*
Dog’s breed or mix (if known)
Sex and neuter/spay status*
Where is your dog usually living?*
Are you interested in:*

Remote consultation only (video/phone)In‑person visit at my location (if available)In‑home visit (your home)Not sure yet
Section B – Presenting Problem (Owner’s Story)
In 1–2 sentences, what is the main behavior problem you want help with?*
How long has this been going on?*

Less than 2 weeks2–8 weeks2–6 monthsMore than 6 months
Has the behavior gotten:*

BetterStayed about the sameWorse over time
Why do you think this behavior is happening? (There’s no wrong answer; I just want your perspective.)
What are your top 1–2 goals for your dog over the next 3–6 months?
Section C – Risk & Red Flags (Triage)
Has your dog ever:*

Growled, snarled, or snapped at a personBitten a person (contact with skin)Bitten another dog or animalCaused bruising, punctures, or needed medical/vet careNone of the above
If yes, briefly describe the most serious incident (who, what happened, where on the body, and any medical treatment).
Does your dog show problem behavior in any of these contexts? (check all that apply)

When visitors enter the homeAround the bed, couch, or furnitureAt doors/windows, barking or lunging at passersbyIn the yard or at the fence/invisible fence lineAround food, toys, or chewsWhen left alone or separated from peopleWith children in the homeWith other dogs in the homeOther (please specify)
Are there children in the home or who regularly visit?*

Yes – under 5Yes – 5 to 12Yes – teensNo
How is your dog currently contained when you’re gone?*

Crate/kennelLoose in some roomsLoose in the whole houseYard (fenced)Yard (invisible fence)Other
Right now, is anyone at immediate risk of serious injury from your dog?*

YesNoNot sure
Are you able to safely manage your dog until we speak? (using doors, gates, leashes, muzzles, etc.)*

YesMaybe, but it’s hardNo
Section D – Medical & Vet
When was your dog’s last full veterinary exam?*

Within the last 3 months3–12 months agoMore than a year agoNot sure
Any known medical issues, pain, or mobility problems? (brief)
Current medications or supplements (including behavior meds, if any).
Section E – Logistics & Modality
Which days/times are generally best for you for a 20‑minute phone call?*

Weekday morningsWeekday afternoonsWeekday eveningsWeekends
Are you open to sending short videos of your dog’s behavior (when safe to do so) before a full consultation?*

YesNoMaybe, need help figuring out how
How did you hear about Southeast K9s, LLC?
In our 20‑minute call we’ll review safety, possible contributing factors, and next‑step options, which may include a full consultation and/or veterinary follow‑up.
Should be Empty:

Free 20‑Minute Behavior Phone Call – Intake Form

Section A – Client & Dog Info

Section B – Presenting Problem (Owner’s Story)

Section C – Risk & Red Flags (Triage)

Section D – Medical & Vet

Section E – Logistics & Modality