Behavior Intake Form

  • Behavior Intake Form

    Christi Chapman, ABCDT, Professional Dog Trainer MiRae Yellowbird, Apprentice Trainer
  • Before we begin, do you have a preference on trainer?
  • I am filling out this form for:
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  • May we text you at the above phone number?*
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  • May we text you at the above phone number?*
  • What is your availability for meeting times? Please choose any that apply.

  • Can you receive digital lesson plans and materials on a computer or device, and are you able to print them off?*
  • Christi suffers from chemical reactivity to certain things. Please check the box next to these products if you use any of them inside of your home. This helps me to prepare so I don't react. We may need to meet outdoors or at an alternate location.*

  • Dog’s gender*

  • Main Concerns

  • Training

  • What requests does your dog respond to?*

  • Please indicate which of the following tools you have tried.*

  • If you selected harness please choose the description below that best fits the style or brand of harnesses you are using. If you don't see an option for your harness below you can describe it in the "other" selection, or you can add the brand and style. If you didn't check harness, select n/a.*

  • Which of the following will cause your dog to become distracted and lose focus from you?*

  • Is your dog crate trained?*

  • Nutrition, Exercise, and Play

  • How do you feed your dog? Please choose all that apply.*

  • What is your dog’s reaction to being left alone?*
  • How long does the reaction last?*
  • What is your dog’s reaction to your return?*
  • Where does your dog sleep at night?*

  • Reactive Behavior

  • Please check if your dog reacts aggressively or threateningly in any of the following situations:*

  • Please check if your dog dislikes any of the following:*

  • Has your dog ever bitten hard enough to break the skin or cause injury to yourself, another person, or another animal?*

  • When does your dog bark?*
  • Does your dog exhibit any of the following?*

  • Finished- almost!

  • Date*
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  • You are all done! Please hit the submit button. Once we have had a chance to review this form, someone will contact you to discuss options and schedule an appointment. Thank you!

    Christi Chapman, Professional Dog Trainer
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