Behaviour Intake Form

Please complete this Behaviour Intake form to the best of your ability.

Anything that doesn't apply to you, please mark n/a.

This behaviour intake form only needs to be completed once.

If at any time you have new information though, please let us know by email so we can update our records.

Again, PLEASE NOTE: We do not take severe aggression cases, such as dogs with a bite history causing damage.

If you are not sure, please email info@cathiescanineconnection.com, or contact your Veterinarian.

Thank you, Cathie's Canine Connection & Co. Inc.

Your First Name & pronouns (optional)

Last Name

Email Address

Phone Number

Names, pronouns (optional), and relationship to others in the household (optional)

Names and ages of minor children in the home & pronouns (optional)

Please provide your full address. Note: Sessions are held at the center, unless previously arranged to meet at your home, or outdoors. Maximum travel is 20 mins from Uptown (6th & 6th) in New Westminster.

If Applicable: For Condo's and the like, is there visitor parking? If yes, please explain how / where to access.

If Applicable: What is the building buzzer number?

What training / class did you register for

Dog's Name

Dog's Breed

Spayed or Neutered

Dog's DOB (or approx)?

Attach a photo of your dog (optional)

Vet Clinic Name, Vet name (Dr.) and phone number

We often work in collaboration with client's vets. Do we have your permission to email with your Veterinarian regarding your case?

YesNoI'd like to discuss this with you when we meet

When was your dog's last Veterinary health check. Month / day / year

What was the outcome of the Veterinary health check.

Please attach the most recent record of your dog's vaccinations.

Attach any additional docs

Please outline any health issues your dog may have, or any treatment or medication your dog may be receiving

Where did you get your dog? PLEASE PROVIDE FULL NAME of BREEDER, RESCUE, or ADOPTION Organization.

On what date did you get your dog?

Do you have any other pets, please specify (cat, etc.)

Do you have any specific behaviour concerns with your dog? Please provide details below.

If you answered yes, when did this start, or did you first notice this?

How long has it been going on?

How often does this happen?

One time on a walkSeveral times on a walkMany times on a walkRarely, but does happen

Has your dog experienced any traumatic event(s)? If Yes, please explain in detail.

Has your dog ever bitten another dog, or human? If yes, please provide full details below. Describe the situation. What was happening right before and what exactly happened.

Was there any damaged at all? A mark, a scrap or puncture(s)?

Was there any need for veterinary care?

Was the bite reported to Animal Control? What is the file number?

Have you worked with a trainer? What is their name and credentials?

What is the name of the company?

What training did they teach you?

What was the result of applying this training method?

Did they the trainer do, or teach you to you use any form of punishment or correction?

Did the trainer explain the scientific methods of how dogs learn, and / or why they do behaviours as they do?

Yes, very clearlySomewhatNothing was discussed

If there a specific reason you are not returning to, or continuing with this trainer, please tell us why?

If you have not hired a trainer, what, if anyting, have you tried to do to resolve the behaviour? What worked, and what didn't?

I understand and ACCEPT that behaviour modification alone may not be enough support my dog's case, and that Cathie's Canine Connection & Co. Inc., may refer me to my Vet, or a Vet Behaviourist.

At Cathie's Canine Connection & Co, Inc., (aka CCC), we are Fear Free, Science and Reward Based Trainers. We do not use dominance, force, flooding, or corrections. We are not Alpha, nor Pack Leaders.

Please Read and Accept CCC's Policies & Procedures Read Policies

YesNo

Please Read and Accept CCC's Liability Release and Waiver Form.Read Policies

I have read the waiver, understand and agree to release Cathie's Canine Connection & Co. Inc. affiliates, and assigns from any and all liability.

How did you find out about Cathie's Canine Connection & Co. Inc.? Please provide their name so that we can thank them.

Do you, or your Dog, have an INSTAGRAM account so we can tag you? Tagging isn't guaranteed, but we'll try. What is it?

Thank you for completing our intake form! Please check your email in box for more information on how to prepare.

Thank you.

Cathie's Canine Connection & Co. Inc.