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Call or Text 984-584-2275 (BARK)
melissa@barktobasicstraining.com
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Behavior Issues
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New Client Questionnaire
Home
About Me
Behavior Issues
Puppy Training
Dog Training
Separation Anxiety
Resources
Training Guides
Blog
Videos
Contact Me
New Client Questionnaire
Separation Anxiety Questionnaire
Separation Anxiety Questionnaire
"
*
" indicates required fields
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Occupation
Phone
*
Veterinarian/Clinic
*
Clinic Phone (if known)
Referred By
Pet Information
Pet's Name
*
Breed
*
Age
*
Sex
*
Male
Female
Neutered
*
Yes
No
Age Obtained
*
Where did you obtain this pet?
*
Breeder (if applicable)
Is your dog on any medication?
Yes
No
Please Describe Medication
How long is the dog left alone on an average day?
*
Is the dog left
*
Indoors
Outdoors
Access to both
Is your dog crated or confined on departure?
*
Crated
Confined
If crated, describe crate
Location of crate?
If confined other than crate, describe
Has your dog been left at a kennel, veterinary clinic or with family/friends?
Yes
No
Describe your dog's reaction
Does your dog exhibit any problem behaviors on your departure?
*
Yes
No
If yes, when did this behavior start?
Describe your dog's behaviors when left alone:
Does the behavior differ depending on length of departure or the time of day left alone?
How does your dog act as you or other family members are getting ready to leave? Describe:
Does the behavior differ depending on who is the last to leave the home?
How does the dog react when the family returns?
How long would you like to be able to leave your dog alone?
Do you have family, friends or a daycare facility who might be able to help with your dog while in training?
Yes
No
Please describe
Have you ever left the dog alone in the car?
Yes
No
How did he/she react?
Does your dog react to loud noises?
Yes
No
Please describe
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