Please complete this form ONLY if you have already booked a Consultation!Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *Other Household MembersPlease enter names of any other household members and their relationship with you, if applicable.Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDog InfoIf multiple dogs, you will have chance to enter info for each dog separately. Please add information about every household dog, even if he/she is unrelated to behavior you are concerned with. Dog Name *Breed and/or Size *Guesses are fine!Approx. Age *Gender *Female (Spayed)Male (Neutered)Female (Unspayed)Male (Unneutered)Do you plan on spaying/neutering in next 6 months?YesNoNot sureWould you like to add information for a second dog? YesNoDog Name (Second Dog)Breed and/or Size (Second Dog)Guesses are fine!Approx. Age (Second Dog)Gender (Second Dog)Female (Spayed)Male (Neutered)Female (Unspayed)Male (Unneutered)Do you plan on spaying/neutering in next 6 months? (Second Dog)YesNoNot sureWould you like to add information for a third dog?YesNoDog Name (Third Dog)Breed and/or Size (Third Dog)Guesses are fine!Approx. Age (Third Dog)Gender (Third Dog)Female (Spayed)Male (Neutered)Female (Unspayed)Male (Unneutered)Do you plan on spaying/neutering in next 6 months? (Third Dog)YesNoNot surePlease select up to 3 main issues you would like help withImproved CommunicationGeneral Skills/Basic TrainingAggressive/Reactive or Fearful Behavior towards Strangers/GuestsAggressive/Reactive or Fearful Behavior towards Household MembersAggressive/Reactive or Fearful Behavior towards Unknown DogsAggressive/Reactive or Fearful Behavior towards Household DogsSeparation Related Issues Destructive Behavior, Chewing, EtcPuppy Related Issues (Potty training, mouthing, etc)Behavior Towards Guests (Non-Aggressive)Behavior Towards Cats or Other Small AnimalsOtherPlease describe the behavior issues you are needing help with in as much detail as possible. This helps me prepare for our consult so that I can make sure you can get as much our of our time together as possible! If you have already submitted this information to me, you can skip!If your dogs have any special needs, food allergies, diet restrictions, etc., please list them here:Please select preferred platform for Virtual ConsultationsFacetimeGoogle MeetHow did you hear about me?GoogleInstagram/FacebookOther OnlineFriend or OtherAwesome! Let me know who referred you so I can thank them! File Upload Click or drag files to this area to upload. You can upload up to 2 files. Optional: You can upload any video of the behaviors you would like to address. Please don't put your dog in a bad situation just to get video however! Submit
