Separation Anxiety Intake
Client Name
Location (City, State)
Phone number
Dog's Name
Dog's Age
Dog's Breed
Where was dog acquired? (Shelter/Breeder/Other)
How long has dog been in your household?
How often is your dog being left alone currently?
Have you done any training to address Sep Anx?
How long would you like to leave your dog alone?
What does your dog do when left home alone?
Is your dog currently on anti-anxiety medication?
Please list out the daily exercise and enrichment your dog gets.
For separation anxiety training to work, you really would need to find a way to stop leaving your dog. How do you feel about that?
That's unrealistic
Might be doable
I'm already doing that. My dog is never left alone.
What amount of time is the goal for your dog to be left alone?*