We provide dog training, behavior consulting, dog sport, daycare and in home boarding services. Our staff are certified or working under the supervision of certified trainer.
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Behavior Consult Registration
Please read and agree to the attached Waiver, Informed Consent and Policies PDF (click below).
CCinc Waiver March 2023.pdf
You and Your Household
Please provide the following information to help us serve you better.
Name
*
Email
*
Phone
*
-- Country Code --
+1 - Canada
+1 - USA
+61 - Australia
+44 - United Kingdom
Address
*
-- Country --
Australia
Canada
United Kingdom
USA
Location Preference for Behavior Consultation:
*
On Campus ($130 for the first 90 appointment) - 3414 Melissa Country Way, Lutz, FL 33559
In your home ($150 for the first 90 appointment - $20 Travel fee may apply)
Virtually by Video call ($130 for the first 90 appointment)
No Preference
Select your home type
*
House with fenced in yard
House with yard - no fenced
House with no yard
Apartment/Condo - no yard
Other
Other home type
Preferred time of day and day of week for your training session, please check all that apply:
*
During the day during the week
During the evening during the week
On the weekend
My experience with dogs is:
*
Professional Trainer
Hobby Trainer - Trains daily for sport training advanced goals
Experienced dog owner
New dog owner
Other
Other
Breed/s I have parented
Type of coaching/instruction I prefer:
Let me figure it out as much as possible
Pull out all of the stops & give me as much info as possible & coach me to do it.
I prefer other people to do the dog training for me as much as possible
Describe verbally, demonstrate visually, then be supervised while attempting
How busy is your home?
*
In addition to you, list the names and ages of all people and animals in the household, including yourself
*
How did you hear about us?
*
Drive By
Facebook
Other Social Media
Google
Other Search Engine
Family/Friend/Neighbor
Groomer
Newsletter
Rescue Group
Other Courteous Canine Inc. Clients
Rescue Group
Veterinarian
Other
Would you like your email added to our newsletter list?
-- Select One --
Yes
No
Pet Name
*
Birthday
*
Breed
*
Weight
*
Sex
*
-- Select One --
Male
Female
Spayed or Neutered
*
Yes
No
Unknown
Is your dog microchipped?
*
Yes
No
Unknown
Is this dog or any other dogs fighting with each other in your home?
*
No/yes
1 - What is the main behavior problem or complaint?
*
Dog Aggression
Human Aggression
Kid Aggression
Other
Other
2 - If your dog has bitten a person please describe the severity of the bite?
*
3 - Are there any other behavior problems?
*
Manners
Stealing
Nipping
Biting
Lunging
Barking
Other
Other
4 - If your dog has bitten a dog please describe the severity of the bite?
*
5 - When did you first notice the problem(age of dog)?
*
6mths
1years
1.5years
2years
Always
Other
Other
6 - In what general circumstance does the dog misbehave? What are the triggers?
*
Large Dogs
Small Dogs
Dark Colored Dogs
Female Dogs
Male Dogs
Strangers
Human Males
Human Females
Kids
Squirrels
Cats
Environmental Changes
Other
Other
7 - What should the goal of training be?
*
Reduce problem behaviors
Other
Other
8 - Has this dog had previous training?
*
Yes
No
Unknown
If yes, where?
-- Select One --
Bark Busters
Ketch
DTCT
PetSmart
Petco
Clark Ingram
Sam Ivy
Other Force-Free Trainer
Other
9 - Is the problem getting better, worse, or staying the same?
*
Better
Worse
Same
Other
Other
10 - What have you done so far to try to fix the problem?
*
Positive Reinforcement Training
Sprayed with water
Stopped taking for walks
Stopped attending group classes
Time out
Hit
Shout
Yank
Shock
Other
Other
11 - What is the possible outcome if this behavior is not resolved?
*
Rehoming
Shelter surrender
Return to breeder
Humane euthanasia
Able to keep dog in my home, regardless if behavior continues
Other
Other
12- Acquired dog from:
*
-- Select One --
Shelter/Rescue
Breeder
Private Party
Gift from friend/family member
Inherited
Other
Other
13 - How old was your dog when acquired?
*
14 - Rate your bond with your dog on a scale from 0-10. Ten is the strongest bond possible, zero being no bond. Please list name followed by bond number. IE: Mary-8, Bob-4
*
15 - If the problem behavior were resolved would the bond number go up?
*
Yes
No
Unknown
16 - What is your dog's relationship to the other people and animals in the household (friendly, hostile, fearful)? Please describe.
*
17 - Has this dog had other owners?
*
Yes
No
Unknown
If yes, how many previous owners and why was the dog given up?
18 - How long have you had this dog?
*
-- Select One --
Since Puppy
Other
Other
19 - What do you feed your dog?
*
-- Select One --
Grocery Store Kibble
Super Premium Kibble
Raw
Home Cooked
Other
Brand/Other
20 - How do you feed your dog?
*
Feeding Schedule
Food down all the time
21 - Does your dog finish their food within 10 minutes when you feed them?
*
Yes
No
22 - How is your dog when left alone?
*
No separation distress
Mild separation distress
Moderate separation distress
Severe separation distress
Other
Other
23 - How is your dog during thunderstorms/fireworks?
*
No issues
Mild noise issues
Moderate noise issues
Severe noise issues
If noise issues, then how do they react?
24 - Does your dog show teeth, get stiff or raise hackles when you approach?
*
Dog's food bowl
Dog chewing toy
Dog eating treat
Dog where they are laying
Dog guards from other dogs
Dog guards from cat(s)
Have not seen
Other
Other
25 - How is your dog with strangers?
*
Happy to see them
Fearful
Angry
Bites
Barks and Lunges
Unknown
Other
Other
26 - How do you exercise your dog?
*
Leashed walks
Backyard games
Run with dog
Bike with dog
Other
Other
27 - Length of time of exercise:
*
10 minutes/day
10 minutes/week
20 minutes/day
20 minutes/week
40 minutes/day
40 minutes/week
More than 40 minutes/day
More than 40 minutes/week
Unknown
Other
Other
28 - Does your dog have any medical conditions?
*
Yes
No
Unknown
If yes, please indicate:
Vision problem
Hearing problem
Luxating patellas
GI problems
Food allergies
Airborne allergies
Heartworm positive
Hip dysplasia
Elbow dysplasia
Poor structure
Other
Other
29 - On heartworm prevention?
*
-- Select One --
Yes
No
Unknown
30 - Please list any medication your dog takes:
*
31 - What does your dog's stools look like?
*
-- Select One --
Loose - pudding
Loose - but formed
Well-formed but huge
Well-formed and normal
Other
Other
32 - Where does your dog sleep at night?
*
Crate
MBR Floor
MBR Bed
Laundry Room
Loose in house
Other
Other
33 - How many hours a night does your dog sleep?
*
34 - Is the sleep interrupted?
*
-- Select One --
Yes
No
Unknown
35 - How well does your dog relax in your home when there is no activity?
*
-- Select One --
Well -relaxes or sleeps most of the day
Has a hard time sitting most of the time
Paces sporadically
Paces constantly
Wants to play constantly
Other
Other
36 - Does your dog have crate anxiety?
*
-- Select One --
Yes
No
Unknown
37 - Do you use a groomer?
*
-- Select One --
Yes
No
Unknown
Any problems with groomer?
-- Select One --
Yes
No
Unknown
If yes, what kind of problem?
38 - Do you use a pet sitter?
*
-- Select One --
Yes
No
Unknown
If yes, sitter:
39 - Do you use a boarding kennel?
*
-- Select One --
Yes
No
Unknown
If yes, name of kennel:
40 - Do you use a day care?
*
Yes
No
Unknown
If yes, name of day care:
41 - What does your dog do when you have guests?
*
-- Select One --
Ok
Reserved
Happy to see them
Fearful
Barks and lunges
Has to be put up
Other
Other
42 - How does your dog behave around children?
*
-- Select One --
Ok
Reserved
Happy to see them
Fearful
Barks and lunges
Has to be put up
Other
Other
43 - How does your dog behave with the veterinarian?
*
-- Select One --
OK
Reserved
Freezes
Afraid
Shuts Down
Very happy and excited
Has to be sedated
Has to be muzzled
Other
Other
44 - How does your dog behave around other dogs?
*
-- Select One --
Ok
Reserved
Happy
Ignores, more interested in people
Afraid and cowers
Barks and lunges
Dog aggressive
Other
Other
45 - Please indicate if your dog gets stiff, growls or shows teeth when:
*
Reaching for collar
Reaching for feet
Hugging
Handling of mouth
Near other dogs
At the vet
Near strangers
Have not seen
Other
Other
46 - If your dog is on leash with you and barks or lunges at another DOG it is because:
*
My dog likes other dogs and wants to meet them and play
Not sure - Need help to figure out
My dog is nervous about the other dog and unsure how to act around them
My dog dislikes other dogs and wants to let them know
My dog does not bark or lunge at other dogs
Other
Other
47 - If your dog is on leash with you and barks or lunges at a PERSON they don't know, it is because:
*
My dog likes meeting new people and wants to greet them
Not sure - Need help to figure it out
My dog is nervous around new people and unsure how to act around them
My dog dislikes stranger and wants to let them know
My dog does not bark or lunge at strangers
Other
Other
48 - What toys and food does the dog like?
*
Cheese
Hot Dogs
Disc
Dog Treats
Tug Toys
Tennis Ball
Other
Other
VACCINE INFO: DHLPP
*
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