Behavior Mod Program Application

Investment: $675 (Afterpay accepted!)

Program includes:

Initial consultation (1.5 hr) to go over history, routines, known behaviors, problem behaviors, etc.
3 additional follow-up lessons (1 hr each) to review previous training, address questions/concerns, and add new training exercises
Written outline of training exercises, and product recommendations
Access to monthly client meet ups for additional in-person guided practice
Email/phone support between lessons
Informational handouts to aid in training
Training can take place at your home, or at a local pet friendly establishment/area

AT THE TIME OF SUBMITTING THIS FORM WE ARE READY TO BEGIN TRAINING ASAP.(required)

I UNDERSTAND I WILL BE EMAILED A FORMAL CONTRACT AND PRE-PAID INVOICE FOR THIS PROGRAM. BOTH ARE TO BE COMPLETED WITHIN 48 HOURS UPON RECEIPT.(required)

Afterpay needed for payment-please add this payment option to my invoice ($50 fee added to the training program price. Eligibility is determined by the Afterpay company.)

To preview the formal contract, click here. This contract is NOT modifiable.

Full Name(required)

Phone(required)

Email(required)

FULL Home Address(required)

I UNDERSTAND THAT THE TRAVEL RANGE IS 20 MILES MAX FROM THE PINCKNEY PUBLIC LIBRARY. (required)

Please select your weekday availability for scheduling lessons:

select all that apply(required)

Mornings (11a) Afternoons (12-3p) Evenings (3-7p)

Dog Name(required)

Breed(required)

Colors/Markings(required)

Male or Female?(required)

Choose one(required)

Spayed (Females) Neutered (Males) Unaltered Will alter in future

Approximate Age/DOB(required)

Date acquired(required)

Where did you get your dog from?(required)

How old was your dog when you acquired them?(required)

Describe your training goals:(required)

I UNDERSTAND JACQUELINE DOES NOT OFFER TRAINING FOR THERAPY DOGS, SERVICE DOGS, PROTECTION, SPORT/AGILITY, SEPARATION ANXIETY, OR INFANT/BABY INTRODUCTIONS. (required)

Please list human occupants in your home, and their ages:(required)

Please list other animal occupants in your home, and their ages:(required)

Who is your veterinarian?(required)

Date of last veterinary exam:(required)

I UNDERSTAND I WILL BE REQUIRED TO PROVIDE A COPY OF MY DOGS VACCINATION RECORDS TO JACQUELINE AT THE CONSULTATION. IF MY DOG IS NOT UP TO DATE ON RABIES AND DISTEMPER, THE REMAINING LESSONS WILL BE ON HOLD UNTIL MY DOGS IS CURRENT ON VACCINATIONS. (required)

Is your dog currently on medications? Do they have any medical conditions or allergies? If yes, please list and/or describe: (required)

Please describe prior training history (including with any other training companies or trainers):(required)

Please describe all instances of aggression (including attempted and actual bites), and approximate dates (if your dog has not shown aggression, use N/A):(required)

What was your response to your dog immediately after instances of aggression or reactivity? (if your dog has not shown aggression, use N/A):(required)

When do behavior issues occur? Please be as detailed as possible.(required)

I UNDERSTAND THAT PROFESSIONAL TRAINING INVOLVES LEARNING HOW TO TEACH MY DOG ON MY OWN. TRAINING TAKES TIMES, AND CONSISTENT EFFORT, TO CREATE CHANGE. I AM READY AND ABLE TO COMMIT TO FOLLOWING A TRAINING PROGRAM. (required)

Training by Jacqueline, LLC

Behavior Mod Program Application

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Behavior Mod Program Application

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