This form will give me specific information about your dog’s separation anxiety.

You will also need to fill out a behavior modification intake form.

i.e. Pacing, panting, whining, sleeping, following you around, etc.
i.e. Barking, screaming, destruction, urination, defecation, etc.
Furniture, doorways, near windows, etc.
i.e. Kennel, bedroom, backyard, full run of the house, etc.
Do you kennel your dog when you leave? *
i.e. Try to escape, drooling, soiling the kennel, vomiting, self-injury, etc.
i.e. Try and soothe, ignore, distract with toys, etc.
Have you sought out the help of any other trainer or behavior consultant? *
Your name *
Your name
Your cell phone number *
Your cell phone number
Your address *
Your address