Intake form

Thanks for taking that first step to improving your dog’s well-being! To get to know you and your dog, fill out this intake form.

Depending on the amount of information you’ll provide, this may take 20-30 minutes. Rest assured that I’ll always reply via email, whether or not I accept your case. Thanks again!

Average response time: 24-48 hours

← Back

Your intake form is on its way

Your name

Your mobile number

Your location

Do you live in a busy part of the city, in a condo, in a village or subdivision, and the like? Be as descriptive as possible.

Your occupation

Your dog’s background

Dog’s name

Dog’s age

Dog’s birthday (YYYY-MM-DD)

Dog’s biological sex(required)

Male

Female

Breed(s)

How did you acquire your dog? Check all that apply.(required)

Purchased from a pet store or local breeder Purchased from a preservation or ethical breeder Purchased from a family member or friend Adopted from a local shelter or rescue organization Adopted from a family member or friend Adopted from a foster home Rescued due to abandonment, hoarding situation, or neglect

If you adopted your dog, how long has the dog been in the previous location?

If you adopted your dog from a local shelter or rescue organization, provide their name and website/social media link.

Share a link to a photo scan of your adoption certificate or letter from your dog’s veterinarian. For Google Drive links, remove ?usp=sharing from your links.

Intact or spayed/neutered?(required)

Intact

Spayed/neutered

Your dog’s diet

Your dog’s feeding schedule

Medical history

Date of latest Rabies vaccination (YYYY-MM-DD)

Upload a scan of your dog’s Rabies vaccination record to an online folder or album. Share the link below. For Google Drive links, remove ?usp=sharing from your links.

Home setup

Who is the dog’s primary guardian?

How long has the dog lived in your home?

Who else lives in the home? Check all that apply.(required)

Cats, birds, and other animals Children 7 years old or younger Young adults or teenagers Other adults (for example: seniors, family members, roomates, helpers) Other younger dogs Other senior dogs

Does the dog live inside with the family or outside of the house?(required)

Inside with the family

Outside of the house

If your dog lives outside, provide the reason(s) why this is your setup.

Is your dog crate trained?(required)

Yes

Management tools available in your home

Upload 3-5 photos or videos of the streets or routes where you walk your dog to an online folder or album.

Canine enrichment

Enrichment is meeting your dog’s needs, so they can perform species-typical behaviors in safe, healthy, and appropriate ways. Read this post for more information.

Do you provide enrichment activities for your dog?(required)

Yes

If you answered “Yes” in the previous question, list down the physical or mental stimulating activities your dog receives everyday.

Number of hours your dog sleeps everyday

Learning history

Describe your dog’s socialization experiences.

Tools you use on outdoor exposures (check all that apply)(required)

Collar and short leash (6 feet or shorter) Collar and long leash (8 feet or longer) Harness and short leash (6 feet or shorter) Harness and long leash (8 feet or longer) No tools. My dog walks off-leash Stroller or something similar

List 3-5 of your dog’s favorite things or experiences.

List 3-5 of your dog’s least favorite things or experiences.

If your dog has any dog training experience in the past, what kind of training was done or did they go through?

Is your dog currently going through private dog training sessions or board-and-train?

Behavior assessment

Was there any incident or experience that made you decide to ask Diwa Dogs for help?

What are the behaviors you need help with? Provide as much information as you can.

Has your dog bitten anyone or any other animal?(required)

Yes No

If yes, provide an assessment of your dog’s bite level.

Resource: Dr. Ian Dunbar’s Dog Bite Scale

How long has your dog been displaying these behaviors?

Where in the house or outdoor environment do the behaviors usually occur?

Describe the things, events, or individuals involved and how they trigger your dog’s behaviors.

Describe your dog’s body language exactly as how you see them with your eyes.

What happens after the behavior occurs? How do you respond to the behavior?

In the past, what have you tried to change the behavior?

What behaviors do you want to see in your dog? What do you want to achieve with your dog?

Number of hours per day you can dedicate to training

Any other information you think will be helpful?

I agree to set up WhatsApp on my devices for my training sessions and communication with Diwa Dogs.