Name
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First Name
Last Name
Email Address
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Phone
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(###)
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City, State
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Dog's Name
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Dog's Date of Birth (approx. if necessary)
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Dog's Breed or Mix
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Sex:
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Has your dog nipped or bitten and dog or person? If yes, was medical attention needed and what are the details?
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Yes
No
If yes, please provide specific details here:
How many times and to whom they were inflicted. Provide any details of the incident(s) as to what may have caused it, how severe was the bite(s), was medical attention needed and was the bite(s) reported?
Availability: Are you available to attend set appointment blocks during business hours (Monday–Friday, 9 AM–5 PM) every two weeks?
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Yes
No
If no, please explain your availability:
Time Commitment: Can you dedicate 30–45 minutes, 4-5 days a week, to work with your dog outside of sessions, plus additional time for office hours, email communication, and accountability and tracking?
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Yes
No
If no, please describe your current time constraints:
Behavior Goals What are the top three behavior challenges you want to address with your dog?
1.
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2.
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3.
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Prior Experience: Have you worked with a trainer or behavior consultant before?
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Yes
No
If so, please share your experience.
Training Philosophy: Are you open to learning about evidence-based, humane behavior change methods that focus on building trust and understanding with your dog?
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Yes, I am eager to learn!
Maybe, I have some questions.
No, I prefer other methods.
6. Financial Resources What is the range of money you are willing to invest in your dog’s behavior journey?
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$0-$500
$500-$1500
$1,500-$3,000
$3,000-$5,000
$5,000-$7,000
$7,000 +
Support System: Do you have a support system (family, friends, etc.) that can help implement your dog’s behavior plan if necessary?
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Yes
No
Expectations: Are you prepared for a 1-6+ month commitment to working on your dog’s behavior with professional guidance and consistent follow-through?
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Yes
No
If not, what is your ideal timeline?
Accountability: Are you willing and comfortable using accountability tools such as progress tracking, video submissions, and attending office hours to ensure ongoing communication and commitment to your dog’s behavior journey?
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Yes
No
Why Now? Why is now the right time for you to address your dog’s behavior challenges?
