Separation Clients

New Client Enrolment Form

Your Information

First Name *

Last Name *

Email *

Phone *

Address *

City *

Suburb *

Postal code *

Your Dog's Information

Dog(s) Name *

Breed of Dog(s) *

Age of Dog(s) *

Weight of Dog(s) *

Is the dog spayed/neutered? *

Is your dog microchipped? *

Is the dog an indoor dog or outdoor dog? *

General Information

How did you come to owning the dog? *

If you selected other, please specify

How often is your dog exercised? *

Which ways do you exercise your dog most (you can select more than one) *

What type of socialisation has your dog had? *

Which of the following best describes your dogs social tolerances towards other dogs? *

How does your dog behave towards other people? *

What previous training has your dog had? Select all that apply *

Who is your regular veterinarian? *

How best describes your dogs relationship with people in the home *

If you have other pets in the house, how would you describe their relationships? *

Does your dog have any allergies or intolerances? *

Alone Time

How long has your dog been in the home? *

Tell us about what it looks like when your dog is left alone. Please give as much information as possible on the behaviours you see *

How long is your dog currently being left alone for? *

Can you adjust your schedule so that your dog will not have to be left alone during training for a while? (Note this does not mean you need to be the one home with your dog all the time) *

Have you done any previous training to address your dog's separation related behaviour? *

Have you consulted with your Vet or a Veterinary Behaviourist about the issue? If so, who, and what have they recommended? *

Is your dog currently on, or regularly on, any medication? *

How long would you like to be able to leave your dog alone in the future? (specify in hour range such as 2-4) *

Is there anything else you would like to add about your goals, experience or circumstances? Eg, you have a time limit, you have had neighbour/council complaints, have a baby on the way or anything else. *

As well as the trainer you have selected, we sometimes have another team member sit in on our training sessions for learning and development purposes. Do you consent to this happening in your training session? *

How did you hear about us? *

Is there anything else you would like to add? *

Please note to submit this form you must have completed all of the above fields. If it does not take you to a submission page after clicking the submit button then you may have missed sections of the form. Please go back and review. Missed or incorrect sections will be noted in red text.