Behavior United, LLC Behavior Intake Form

Behavior Intake Form
The insight and knowledge you share about your pet through this quick form allows us to customize a plan before sharing solutions. A certified professional trainer is only a click away. Submitting this form brings you one step closer to gaining more quality pet time! After this form has been submitted and reviewed, scheduling can begin.
Your Information
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Primary Phone Number*

Area CodePhone Number
Other people in the home:*
Would you like to receive periodic email updates about upcoming events, classes, and promotions?*

YesNo
How did you hear about us?*
Pet Information
Pet(s) to be seen in session*
Other Pet(s) in home
Please list any other pets in the household and their species, breed, and age
Is your pet house and/or crate-trained?*
How long and where is your pet left alone each day? (If Separation Anxiety, how long can your dog be alone?)*
Pet exercise type/frequency plus mental enrichment like chews and food puzzles*
Equipment used on walks*
Type of collar/harness/leash
Medical History
Veterinarian Name/Practice*
Please list any previous or current medical issues your pet has had:*
(Please include any dietary restrictions)
Please List Vaccinations and Dates for Rabies/DHLPP:*
Have you spoken to your vet about your dog's behavior challenges? List any/all behavior medications. *
Training and Behavior History
Please list any known previous training/methods used:*
What do you use to reward your pet? What is your pet's response?*
What type of correction/punishment do you use with your pet? What is your pet's response?*
List behaviors your dog already knows how to do*
(sit, down, etc.)
What are your training goals/reasons for contacting us? *
Which training package are you interested in?*
Which version of the training package are you interested in? (Separation Anxiety is All Online)*
Has your pet ever bitten another animal or person? Please describe below and include a description of bite location and severity plus if medical attention was required*
Is your pet possessive or protective of anything? Please describe below:*
Is there anything you would like to add about yourself or your pet(s)?
Should be Empty:

Behavior Intake Form

Your Information

Pet Information

Medical History

Training and Behavior History