Pre-Assessment Form

Name *

First Name

Last Name

Phone *

(###)

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Emergency Contact *

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Thinking about your dog's behaviour, please tick all that apply:

Startles easily

Barks/howls excessively

Shows anxious behaviour

Shows aggressive behaviour

Pulls on the lead

Steals food or objects

Resource guards - people, food, toys

Destructive tendencies

Jumps up

Shows obsessive behaviour

Shows separation anxiety

Mouths on hands/clothing

Bites - hard bite, redirection