Date of Contact *
Date of Contact
Name *
Name
Phone *
Phone
Altered? *
Dog's Sex *
Date of Adoption *
Date of Adoption
Primary Behavior Issue(s)
What issues or behaviors are you looking for help with?
Human Aggression/Fear
Animal Aggression/Fear
General Behavior
Manners
Onset of Issue
Onset of Issue
When did the problem first begin?
Bite History
Bite Levels (Has your dog ever bitten anyone? What were the circumstances that led to the bite – what happened? Did the bite leave a scratch, bruise, puncture?)
What is the worst result that has occurred?
What is the worst result that has occurred?
Initial Consult
Address
Address
Date of consult
Date of consult
Time
Time
Paid?
$