Puppy Intake Form

Please complete this Separation Anxiety Intake form to your best of your ability.

Anything that doesn't apply to you, please mark n/a. When you click submit you will receive an email inviting you to schedule a complimentary 20 minute Discovery Call.

If you don't see it in your email right away, please check your spam, in case it was filtered out.

Talk to you soon!

Your First Name & pronouns (optional)

Last Name

Home address

Phone Number

Dog's Name

What is your Dogs Date of Birth?

On what date did you get your dog?

Do you currently leave your home dog alone. If yes, for how long?

What makes you feel that your dog has separation anxiety?

My neighbours have complained about my dog barkingI have a doggie camera and can see that my dog is upsetI find 'evidence' of things my dog has done, when I return homeMy landlord or Strata has contacted me about my dog barking

When did these behaviour start?

If there are multiple people living in the home, is your dog more attached to one person, more than others? It so, who?

Have you ever left your dog home with someone else?

Yes I have, and my dog was completely dog was completely fineYes I have, and my dog was still very upsetNo, I have never left my dog with anyone

What have you tried, if anything so far, to resolve your dog's separation anxiety?

Have you done any formal training, or separation anxiety training with your dog?

What is the name of the company, and the name of the trainer? What are their credentials?

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

Please write out, in point form, your dog's daily schedule. Ex. Sleep habits, meal times and diet, length of walks (if you are), dog parks, playtime (what kind and for how long).

Veterinarian name

Have you spoken with your vet about your dog's separation anxiety. If yes, what did they suggest.

To get the best results from Separation Anxiety training, you would really need to find ways not to leave your dog alone anymore. Is this something that you can do?

Yes, I can make arrangementsMy dog is never left along.Maybe, but I would appreciate any suggestions you may have.

Do you have any other information you'd like to share, or any other specific behaviour concerns with your dog? Please provide details below.

If you'd like me to review a video of your dog alone, please upload a file.

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

Yes, I acceptNo, I do not accept

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

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

Attach a photo of your dog.

How did you hear about us?

Thank you for completing our intake form!

We look forward to connecting with you.