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Behavior Modification Intake Form

Behavior issues can be complicated, and the small details often help us understand what’s really going on. I know this form has a lot of questions — especially when emotions may already be running high — but the more specific you can be, the better I can support you and your dog.

For any behavior, it’s very helpful to know:
•    what lead up to this point (how did the day unfold)
    •    what happened right before the behavior
    •    what the behavior looked like (your dog’s exact actions and body language)
    •    how you or others responded in the moment

These details can make a big difference in finding the why behind the behavior and creating a plan that truly fits your dog.

The same goes for questions about daily routine, mental and physical needs, environment, medical concerns, and your own emotional “bank.” Every question has a purpose, and the information you share helps me give you the best possible guidance.

Physical health can also play a bigger role in behavior than many people realize. Pain, gastrointestinal discomfort, allergies, or other underlying issues can directly impact how a dog feels and responds to the world — even when the signs are subtle or easy to miss. Because of this, I ask about veterinary evaluations that go beyond routine wellness visits to help rule out medical causes contributing to behavior.

There is no judgment, ever. Just be honest and do your best — I’m here to help you and your dog every step of the way.

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How long does your dog take to settle and be back to baseline after an episode or trigger?

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How does your dog typically react to a new person entering its space, home and away from home?

Curious

Cautious

Hides

Barks

Launching

Neutral

Recovers quickly

Stays fearful

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Is your dog conditioned wearing a muzzle? (Conditioning = slow, positive introduction so your dog is comfortable)

Yes

No

If recommended for safety, are you willing to condition your dog to wear a muzzle using reward-based training? (Conditioning = slow, positive introduction so your dog is comfortable)

Yes

No

Unsure/Would like to discuss further

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Has your dog received any previous professional training? If so, which training methods were used?

Yes - professional training

No - owner training

Science-based - reward-focused, no force/itimidation (clicker, shaping, games, food)

Balanced - corrections & intimidation some treats(spray, prong, leash pops, e-collar)

Aversive/compulsive - heavy punishment or intimidation (flooding, helicoptering, Dog Daddy style).

Has not received training yet

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What type of equipment was PREVIOUSLY used with your dog? (Select all that apply — this helps guide next steps)

Harness with using the front clip

Harness with using the back clip

Flat Collar

Martingale (nylon)

Head Collar

6 Foot Leash

Long Line

Jogging Leash

Crossbody Leash

Retractable Leash

Bungee Leash

Martingale (chain)

Prong Collar (metal)

Prong Collar (Starmark)

E-Collar

Other

What type of equipment do you CURRENTLY use with your dog? (We do not allow retractive leashes, prong or e-collars, but we're happy to guide you in transitioning to safer gear.)

Same as previously used

Harness with using the front clip

Harness using the back clip

Flat collar

Martingale (nylon)

Head Collar

6 Foot Leash

Long Line

Jogging Leash

Crossbody Leash

Retractable Leash

Bungee Leash

Martingale (chain)

Prong Collar (metal)

Prong Collar (Starmark)

E-Collar

Other

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On a typical day, how much time are you realistically able to dedicate to training and enrichment? Both are equally important.

5-10 min

10-20 min

20-40 min

It varies a lot

Is your dog crate trained? Crate/Confinement Comfort How comfortable is your dog in a crate, pen, or similar safe space, when left alone?

Not crate trained

Very comfortable - will rest or nap calmly and relaxed, able to eat, even with door closed.

Tolerates it for short periods but may whine or paw at times

Shows stress (panting, barking, not eating, drooling, escape attempts)

Cannot tolerate at all — panics or becomes very distressed

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Is your dog ever left outside without direct supervision (e.g., while you are not home or not actively monitoring them)?

Yes

No

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Did your dog displayed any unusual symptoms such as coughing, sneezing, or upset stomach in the last 30 days?

Yes

No

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Does your dog follow a regular feeding schedule (such as am & pm meals), or do they have food available freely throughout the day?

On a schedule

Free Fed food available throughout the day

Kibbles

Wet Food

Raw Diet

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Has a veterinarian specifically evaluated your dog to rule out pain, GI issues, or other medical causes for this behavior?

Yes

No

Not yet

is your dog CURRENTY on any medication (not including Heartworm, tick preventions)

Yes

No

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