This intake is a precursor to the details that will be gathered once we begin working together.

STEP 1: Let's start with you

First Name *

Last Name *

Dog's Name *

Phone *

Email *

Address *

City *

State or Province *

Country *

Country

Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Cote D"Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea People's Democratic Republic
Republic of Korea
Kuwait
Kyrgyzstan
Land Islands
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
North Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Federated States of Micronesia
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Eswatini
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
UK
Ukraine
United Arab Emirates
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
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STEP 2: Introduce us to your dog

Breed of dog

What is your dog's sex?

Female (spayed)

Female (not spayed)

Male (neutered)

Male (not neutered)

What is their birthdate?

Dog's Age Today

From where did you obtain your dog?

Name of breeder or rescue

The name and phone number of your current veterinarian

Dog's Weight

Was this training deemed mandatory by the rescue organization?

Yes

What is your primary goal for participating in this program?

STEP 3: Let's dig a little deeper

The details you provide here will help us begin assessing your dog's needs and allow us to make specific learning recommendations for your situation.

How old was your dog when you brought them home?

What type of food (including brand name) does your dog eat? Please include frequency of meals, and how long it takes for your dog to empty their dish.

What was the date of your dog's last medical checkup? *

Does your dog have any allergies or sensitivities?

Does your dog have any past/present health concerns?

Please provide a list of any medications your dog is taking currently, or has taken in the last 2 years

Can your dog comfortably be left home alone? *

What is the longest length of time your dog gets left at home alone (no humans in house) during the day?

What style of home do you live in? (For example: apartment, condominium, townhome, semi-detached, detached, etc.)

Are there additional humans or animals that share the home with your dog?

Do you have other caregivers for your dog? Include past or present dog walkers, daycares, neighbours, family, etc.

Please tell us which human(s) do a majority of your dog's walks

How many times a day do you take your dog off the property, and how long is their longest walk?

What type of walking gear does your dog wear?

Would you consider your dog to be good sleeper? For example: does your dog take naps easily, do they sleep through the night, are they easily startled while resting?

Do any of the following cause your dog to become upset or excited? Please select all that apply (more details will be gathered during next stages of our work together) *

People arriving at your door

Seeing people on walks

Seeing people outside your windows or fences

Seeing dogs on walks

Seeing dogs outside your windows or fences

Seeing wildlife on walks

Seeing wildlife outside your windows or fences

Hearing certain sounds while indoors

Hearing certain sounds while outside

Bicycles, skateboards, scooters

Cars, trucks, motorcycles

Shadows, lights, reflections

Does your dog become upset or excited by anything not mentioned above?

How many times per week do you observe these reactions from your dog?

Have you participated in training with this dog in the past? Please provide us with some details, such as the trainer/school name, year of attendance, training method used, and if this training was successful for you.

Are you a robot?

Your Calm Dog Success Story

It starts right here

This intake is a precursor to the details that will be gathered once we begin working together.

STEP 1: Let's start with you

STEP 2: Introduce us to your dog

STEP 3: Let's dig a little deeper

The details you provide here will help us begin assessing your dog's needs and allow us to make specific learning recommendations for your situation.