Intake Question Overview

Behavior Tails, LLC

Intake Questions
Name*

First NameLast Name
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Email*
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Phone Number*
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Phone Number
Please enter a valid phone number.
Physical Address*

Street Address

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CityState / Province

Postal / Zip Code
Mailing Address (if different than physical address):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you find us? Who referred you?*
Person's living in your home & their relationship to you (please list ages for children):*
Brief overview of why you've contact Behavior Tails, LLC:*
Select ALL of the following that apply to your situation:*

Aggression in the homeAggression towards dogsAggression towards other animals in the homeAggression towards small animalsAggression towards peopleAggression when on leashBarkingBasic Manners / TrainingDiggingDestructive Behavior(s)Emotional Support Animal TrainingFear / Anxiety IssuesGuarding Food / Toys / PlacesHouse Soiling / Potty TrainingNew PuppyNot coming when calledPreparing the animals for a new baby in the homePulling on LeashSeparation AnxietyService Dog TrainingSocializationStealing thingsTherapy Dog TrainingWanting guidance on selecting a new dog/puppyOther
Has this dog ever bitten a person?*

YesNo
Has this dog ever bitten another animal?*

YesNo
How many dogs are in the home*

1234Other
Please select the services you are signing up for:

Basic Skills / Foundation TrainingGroup ClassesThe Academy (drop off day training)Problem Solving Session (not aggression or anxiety)Consultation for Dog Directed AggressionConsultation for Human Directed AggressionConsultation for AnxietyService Dog TrainingTherapy Dog TrainingBoard & TrainOther
Dog #1 Information
Dog #1: Name*
Dog # 1: Age / Sex / Breed*
Dog #1: Birthday if known*
Dog #1: Date they joined your family & where did you get them?*
Dog #1: Date of last physical exam by a Veterinarian?*
Dog #1: Date of last blood work?*
Dog #1: Is your dog up to date on exam/vaccinations/recommendations by your Veterinarian?*
Dog #1: Any health conditions or medications?*
Dog #1: Any allergies or food sensitivities?*
Dog #1: Please upload a photo or PDF of your dog's current Rabies Vaccination. If you have trouble uploading this please email us at info@behaviortails.com or give us a text/call at 828-565-1050 for help

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Dog #1: Please upload a photo or PDF of your dog's current vaccination records. If you have trouble uploading this please email us at info@behaviortails.com or give us a text/call at 828-565-1050 for help

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Dog #1: Upload a cute photo of your dog if you'd like to share a photo with us :)

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Dog #2 Information
Dog #2: Name
Dog # 2: Age / Sex / Breed
Dog # 2: Birthday if known
Dog #2: Date they joined your family & where did you get them?
Dog #2: Is your dog up to date on exam/vaccinations/recommendations by your Veterinarian?
Dog #2: Date of last physical exam by a Veterinarian?
Dog #2: Date of last blood work?
Dog #2: Any health conditions or medications?
Dog #2: Any allergies or food sensitivities?
Dog #2: Please upload a photo or PDF of your dog's current Rabies Vaccination. If you have trouble uploading this please email us at info@behaviortails.com or give us a text/call at 828-565-1050 for help

Cancelof
Dog #2: Upload a cute photo of your dog if you'd like to share a photo with us :)

Cancelof
Dog #3 Information
Dog #3: Name
Dog #3: Age / Sex / Breed
Dog #3: Birthday if known
Dog #3: Date they joined your family & where did you get them?
Dog #3: Is your dog up to date on exam/vaccinations/recommendations by your Veterinarian?
Dog #3: Date of last physical exam by a Veterinarian?
Dog #3: Date of last blood work?
Dog #3: Any health conditions or medications?
Dog #3: Any allergies or food sensitivities?
Dog #3: Please upload a photo or PDF of your dog's current Rabies Vaccination. If you have trouble uploading this please email us at info@behaviortails.com or give us a text/call at 828-565-1050 for help

Cancelof
Dog #3: Upload a cute photo of your dog if you'd like to share a photo with us :)

Cancelof
Dog #4 Information
Dog #4: Name
Dog #4: Age / Sex / Breed
Dog #4: Birthday if known
Dog #4: Date they joined your family & where did you get them?
Dog #4: Is your dog up to date on exam/vaccinations/recommendations by your Veterinarian?
Dog #4: Date of last physical exam by a Veterinarian?
Dog #4: Date of last blood work?
Dog #4: Any health conditions or medications?
Dog #4: Any allergies or food sensitivities?
Dog #4: Please upload a photo or PDF of your dog's current Rabies Vaccination. If you have trouble uploading this please email us at info@behaviortails.com or give us a text/call at 828-565-1050 for help

Cancelof
Dog #4: Upload a cute photo of your dog if you'd like to share a photo with us :)

Cancelof
Overview of your home:
What Veterinarian do you use for your dog's routine care?*
Please list all the animals in your home: Name / Species / Breed*
Please describe your dog(s) feeding routine including the food & schedule & details.*
Please describe your daily routine with your dog(s):*
Please describe any training that you've done with this dog:*
Please describe any issues you are having:*
Please describe what you are currently doing or what you have tried to resolve this problem:*
Please describe your goals for training:*
What is your #1 Priority/Goal for you dog
What is your #2 Priority/Goal for you dog
What is your #3 Priority/Goal for you dog
What is your #4 Priority/Goal for you dog
What is your #5 Priority/Goal for you dog
Is there anything else we need to know about your goals or priorities for training your dog?
Questions for dogs joining The Academy
Does your dog jump fences?
Does your dog escape collars? Harnesses?
How does your dog do in a crate? Please specify if there is a difference in behavior whether you are home or away?
When / How much does your dog bark?
Please describe your dog's experiences with other dogs: (including reactions to meeting dogs that are unknown, big/small, old/ young or any other specifics that you know)
Please describe situations you've seen a fearful reaction from your dog:
Does your dog guard any of the following:

CrateBedFood BowlWater BowlToysPeopleSpaces (like a couch)ChewsBonesNoneOther
Does your dog have any sensitivity to being touched:

CollarHarnessFeetEarsTailNoneOther
How is your dog around new people?
Is there anything else we need to know about your dog?
Dog Directed Aggression Questions
Please list the dates & circumstances of the aggressive episodes:
Were the other dogs involved known or unknown? Please give as many details as possible.
Degree of Injuries to the dog(s)

no injuries1-2 shallow puncturesnumerous puncturesdeep puncturesbruisingpunctures that included tearingmultiple bitesthe dog wouldn't let gomajor lacerationsthe animal was killed during the fightOther
Please describe the medical attention needed?
How was the fight stopped?
What happened immediately before the aggressive episode:
What happened immediately after the aggressive episode:
Human Directed Aggression
Please list the dates & specific circumstances of each aggressive episode:
Degree of Injuries to the person

contact with skin but no broken skinscratches to skincontact with clothing only1-2 shallow puncturesnumerous puncturesdeep puncturesbruisingpunctures that included tearingmultiple bitesthe dog wouldn't let gomajor lacerationsOther
What is the location on the body where the bite targeted:
Was medical attention needed? If so, please provide details:
What happened immediately before the aggressive episode:
What happened immediately after the aggressive episode:
Anxiety Specific Questions
Please describe the situation(s) that your dog experiences fear/anxiety:
When did you first see this issue?
What have you tried so far?
Has this problem gotten worse or better since you first saw it?
Board & Train Questions
Does your dog have a history of stomach issues? Diarrhea? Pancreatitis? Not Eating? Other?
Please describe your normal eating / feeding routine for your dog
Do you give Behavior Tails, LLC to give the following options to try and settle the dogs stomach should we feel it beneficial to your dog during their stay with us:

ProbioticsPumpkin SupplementWhite rice + Chicken instead of their foodOther non-medical food supplementNoneOther
Does your dog have a history of ingesting foreign / non-food objects? (dog beds, sticks, toys, etc..) If so please give details.
Does your dog destroy any of the following:

Dog BedsToysAnything plasticKongsanything woodOther
Does your dog jump fences?
Does your dog escape collars? Harnesses?
How does your dog do in a crate? Please specify if there is a difference in behavior whether you are home or away?
When / How much does your dog bark?
Please describe your dog's experiences with other dogs: (including reactions to meeting dogs that are unknown, big/small, old/ young or any other specifics that you know)
Please describe situations you've seen a fearful reaction from your dog:
Does your dog guard any of the following:

CrateBedFood BowlWater BowlToysPeopleSpaces (like a couch)ChewsBonesNoneOther
Does your dog have any sensitivity to being touched:

CollarHarnessFeetEarsTailNoneOther
How is your dog around new people?
Is there anything else we need to know about your dog?
If an emergency medical situation arises, do you give Behavior Tails, LLC permission to take your dog to our local Veterinary Hospital for treatment?
Will we be able to contact you in case of an emergency? If not, please list an emergency contact person who you authorize to make decisions for your dog's health/care.
The person signing this form must be over 18 years of age and the legally responsible party for this animal and by submitting this form they are agreeing that all the information listed is accurate and that you have disclosed any history of aggression or injury that has been caused by the dog.
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Behavior Tails, LLC

Dog #1 Information

Dog #2 Information

Dog #3 Information

Dog #4 Information

Overview of your home:

Questions for dogs joining The Academy

Dog Directed Aggression Questions

Human Directed Aggression

Anxiety Specific Questions

Board & Train Questions