Behaviour Modification Registration Form

Please complete this form to the best of your ability. Short answers that lack required detail will cause the form to be returned to you for further completion. The more information we have, the better we may better assist you.

If so, please stop and visit www.familypaws.com for further direction, or contact Jennifer at the FREE Family Paws Hotline at 1-877-247-3407. You may still be referred back to us, but all cases involving children must go through Family Paws first.
Your full name *
Your full name
Partner's full name (optional)
Partner's full name (optional)
Phone *
Phone
(555-555-5555)
Dog's date of birth *
Dog's date of birth
If unknown, please estimate
(shelter, breeder, other?)
If unknown, please guess
Oftentimes this is necessary and this step saves us time - you can revoke access at any time.
This is where we require a detailed response!
Please be as detailed as possible...include "nips" and attempts as well as actual bites.
Bruising, broken skin, lacerations, tears, stitches, medical treatment?
This is where we require a detailed response!
Warning: do not attempt this in order to be able to answer this question!
Please be as detailed as possible...include "nips" and attempts as well as actual bites.
Bruising, broken skin, lacerations, tears, stitches, medical treatment?
Does your dog have a notice from Animal Control?
Check all that apply
This might include barking, lunging, snarling, attempting to bite, or biting.
Does your dog have a notice from Animal Control? *
Choose all that apply
Please be as detailed as possible...include schools / trainers and methods/tools used.
This is where we require a detailed response! State any training goals that you might have.
Check all that apply (the first two sessions may be required to be seen in-school):