Separation Anxiety | pawsitivepurpose

Street Address

City, State, Zip

Your dog's name

Age of Dog

Dog's breed type or mix type and where was the dog acquired?

How long has the dog been in your household?

How long is your dog currently being left alone?

Can you adjust your schedule so that your dog will not have to be left alone during training for a while?

Have you discussed your dog's separation anxiety with your veterinarian? (explain as needed)

How long would you like to be able to leave your dog alone in the future? (specify in hour range such as 2-4)

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