quarterly Report Date * MM DD YYYY Report is: * My 1st Quarterly Report My 2nd Quarterly Report My 3rd Quarterly Report My 4th Quarterly Report Name * First Name Last Name Email * This is a new address since my last quarterly report * Yes No Address * Address 1 Address 2 City State/Province Zip/Postal Code Country For PTSD and Autism Clients only: Are you still attending therapy sessions? If so, how frequently do you attend? Dog * Dog's Weight (please enter number) * Please list the places you have taken your dog. If applicable please indicate if a new place was visited. * Are you having issues with your dog?(eg. pulling, lunging, jumping,barking, whining)) * Have there been any changes in your lifestyle? (eg. with children, school environment, routine, health) * Are you having trouble maintaining a proper meet and greet? If so, please explain. * Have you used classical conditioning. If yes, please describe. * If you have left your dog home alone, please explain how long, how often, and if (s)he had any issues. * What food is (s)he on and how much? * What treats are you using? * Is your dog on any supplements? * What monthly meds is your dog receiving? * Are you cutting his/her nails? * Any concerns with your dog's ears, teeth, skin, stools? * Has your dog had any health issues or visited the vet since your last report? If yes, please describe. * Please describe your dog's excercise routine including play dates, off leash excercise, walks. * What skills provide you the most benefit? * Have you taught any new skills to your dog? * Please share a recent experience where your dog was invaluable. * If using new veterinary practice, please submit name, address, phone number, and email If you have new emergency contacts for yourself and/or dog, please list below. Thank you!
