Separation Anxiety Intake Form
Share your dog’s history, behaviors, and routine so we can tailor the training plan.
Your Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Dog's Name
*
Dog's Age (in years)
*
Dog's Breed
How long have you had your dog?
How does your dog behave when left alone? (Select all that apply)
*
Barking or howling
Destructive behavior (chewing, digging, etc.)
Toileting indoors
Pacing or restlessness
Attempts to escape
Excessive salivation or drooling
Loss of appetite
Other
How long is your dog typically left alone?
*
Please Select
Less than 30 minutes
30 minutes to 2 hours
2 to 4 hours
4 to 8 hours
More than 8 hours
Never
What have you tried so far to help your dog with separation anxiety?
Has your dog had any previous training for separation anxiety?
Yes
No
What are your goals for this training?
What days and times generally work best for you to schedule your initial assessment?Please select all that apply:
Weekday mornings
Weekday afternoons
Weekday evenings
Weekends
Flexible availability
Thank you for taking the time to complete this form! I'll review your information and be in touch within 24 hours to discuss the next steps.
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