Separation respite form - Play Way Dogs

Let's start the process!*

Name*

First

Middle

Last

Email*

Address*

Phone/text*

What is your dog's name?*

What is your dog's breed/mix, size, and age?*

Is your dog spayed/neutered?*

How long have you had your dog?*

What trainer are you working with for your dog's separation issues?*

Who is your dog's local veterinarian?*

Does your dog have any medical issues? List all medications, including behavioral meds:*

Does your dog have any food intolerances or special diet?*

What length of time can you currently leave your dog alone for, successfully?*

How close to you does your dog need to be when you're home together?*

Is your dog distressed when alone in the car while you run errands? Can they relax in a crate?*

Describe your dog's behavior with other dogs:*

Has your dog ever bitten a dog or human? Describe the circumstances briefly:*

Is there anything else you want me to know before we speak?*