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Name *

First Name

Last Name

Phone *

(###)

###

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What concerning behaviors does your dog exhibit? *

Select all that apply

Self mutilation (bloody paws, excessive licking, etc)

House soiling

Pre-departure anxiety (shadowing, whining, pacing, circling, etc)

Chewing or scratching around doors and windows

Excessive barking, whining, or howling

Extended or anxious greeting upon return

Escape Artistry

Refusing food while alone

None of the above

Other

Have you spoken to your Veterinarian or a Veterinary Behaviorist about your dog's current behavior? *

Yes, Veterinarian

Yes, Veterinary Behaviorist

Yes, both

No

Have you worked with a professional dog trainer for your dog's concerning behavior before? *

Yes

No

Can you adjust your schedule so that your dog will not have to be left alone during training for a while? *

Yes

No

Maybe