Pupsters Home Alone

About You

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Your Name *

First

Last

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Dog Name *

Breed *

D.O.B *

At what age did you obtain the dog? *

Is your dog a rescue? *

Yes No Option 3

How many days per week is your dog walk and for how long? *

How many days per week do you train your dog or give them mentally stimulating tasks? And how long do the sessions last? *

Does your dog have any medical issues? *

Yes No Maybe

If yes or maybe, please expand including any medication/treatments they are undergoing *

Does your dog have any of the following symptoms when left alone *

Barking/howling Toileting Chewing or destroying items Chewing, licking or scratching the exit points Pacing Self Mutialtion Other

If other, please specify *

To the best of your knowledge, how long has your dog suffered with separation anxiety *

Have you used any methods so far to relieve the separation anxiety? Is so, please describe *

On average, how many days per week is your dog left alone? *

What is the longest time your dog is typically left alone for? *

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