Separation Anxiety Questionnaire PhoneYour DetailsLet us know how to get back to you. First Name * Last Name * Email Address * Phone Number * (We will use text notifications during assessments) Dog Name * Breed * Dog Age * How long have you had your dog? * Where did you get your dog? * Breeder Rescue Shelter Friend If none of the above, please explain: Please describe what your dog does when you leave him/her: * Where does your dog stay when you leave? * What is your goal for departures? * What type of dwelling are you in? * Single family home Apartment Townhouse Duplex If none of the above, please explain: What types of exercise, enrichment, training do you do with your dog (what does a day in the life of your dog look like)? * Are there other pets in the household (if so, what type) * Are there other people in the house? * Yes No What have you already tried to help your pet with departures? * Separation Anxiety usually requires temporarily suspending absences to work under the threshold of your pet. Is this something you can do? * Yes No Maybe What are three things that you like most about your pet? * Training plans are usually communicated via Google Sheets, and assessments are done via Zoom. Are you comfortable using this technology? * Yes No Somewhat
