Admin to get started Step 1 of 5 20% Please start by telling us your basic information: Your Name(Required) First Last What is your approximate age group?e.g. 40sAddress(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Home PhoneMobile(Required)Preferred Email(Required) Name(s) of the main dog(s) we will be supporting you with(Required)Breed(s) of the main dog(s) we will be supporting you with(Required)Name(s) of any other dog(s) you haveWhere did you hear about Canine Thinking? WhatsApp Group and Email Please tell us the name's and phone numbers of everyone you would like included in your WhatsApp group(Required)Handy hint - you can press the little + button at the end of the row to add another columnFirst nameLast nameApprox AgeRelation to you (optional) e.g. Partner, Parent, Friend etc.Phone number Add RemovePlease tell us the name's and email address of everyone you would like included in email communications(Required)First nameLast NameApprox AgeRelation to you (optional) e.g. Partner, Parent, Friend etc.Email address Add Remove Insurance It is completely up to you if you wish to provide this information to us, but it can be really helpful, particularly if you are going to claim for any of your behavioural support from your insurance and/or if we need to work with the vet to investigate anything medical that could be related to the behaviour. Do you have insurance for your dog?(This is the main dog we're helping you with) Yes No Prefer not to say What is the name of your insurance provider?When did you take out your insurance policy?DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920What level of cover do you have?If you know, please tell us a bit about what your policy covers e.g. £7,000 per year, £15,000 life time per condition etc.Are there any medical or behavioural exclusions for your dog? Yes No What are they? Your Availability for sessions Please note: The team predominantly work 9-5, Monday -Friday, with some Saturday mornings available. We can sometimes accommodate other times by exception. These need to be agreed specifically with the behaviourist you are working with. Your First Session: It is particularly important that everyone in the house hold attends your first session - this may mean taking some time off work to do this. Going forward, ideally we want as many people in the house hold attending the sessions as possible, however it is okay if only one person is able to attend. What days/times are best to have your sessions?(Required) Monday - Morning Monday - Afternoon Tuesday - Morning Tuesday - Afternoon Wednesday - Morning Wednesday - Afternoon Thursday - Morning Thursday - Afternoon Friday - Morning Friday - Afternoon What other days/times are a flexible possibility to have your sessions if your ideal times aren't available?(Required) Monday - Morning Monday - Afternoon Tuesday - Morning Tuesday - Afternoon Wednesday - Morning Wednesday - Afternoon Thursday - Morning Thursday - Afternoon Friday - Morning Friday - Afternoon No other times What days/times can you absolutely not do?(Required) Monday - Morning Monday - Afternoon Tuesday - Morning Tuesday - Afternoon Wednesday - Morning Wednesday - Afternoon Thursday - Morning Thursday - Afternoon Friday - Morning Friday - Afternoon There are no days that are an absolute no Vet and other professionals To help us give you the best possible support, please tell us about any other professionals who currently see your dog. For vets and other health-oriented professionals (e.g. physios, nutritionists, osteopaths), it also helps us to know who has seen your dog previously, even if they don’t now, to make sure we have a complete history. For your CURRENT VET please remember to complete the separate authorisation form for us to speak with them directly. Should we need this form for any of the other professionals listed below, we will let you know.’Name of your CURRENT main vet practice (where your dog is seen for day to day care)(Required)Name of vet you usually seeIs your dog CURRENTLY being seen at any other vet practices?(Required)e.g. to see a specialist, for acupuncture or herbal medicine, at a different location like a second home Yes No Other vet practicesHandy hint.... click the + on the right hand side to add more rows!Name of practiceAddress/LocationReason for use Add RemoveHas your dog PREVIOUSLY been to any other vet practices? Yes No ListName of practiceAddress/LocationReason for useApprox dates from/to Add RemoveDoes your dog CURRENTLY see any other canine professionals?e.g. physiotherapist, hydrotherapist, massage therapist, osteopath, chiropractor, nutritionist, dog groomer, dog walker Yes No Other professional practicesHandy hint.... click the + on the right hand side to add more rows!Type of professionalNameAddress/Location Add RemoveAnd that's it! Time to submit.....
  
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