Virtual Phone/Skype/FaceTime Consultation

Virtual Phone, Skype or FaceTime Behavior Consultation
Virtual consultations might not be appropriate for all behavior problems. Email Christine at christine@dogology.us prior to submitting this form. Provide a brief description of your dog’s behavioral issue and Christine will reply promptly with a determination.

A completed “Behavioral History Questionnaire” is required for all consultations. The "Behaivoral History Questionnaire" is located at the bottom of the "Behavior Consulting" page at www.dogology.us.

Virtual consultations are 60-minutes long. Additional 30-minute support consults are available (as needed) after the initial consultation.

Consultations will be scheduled after receipt of the questionnaire. Please complete the questionnaire within 7 days of submitting this form.
Full Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number
E-mail *
Which do you prefer? *

Phone Skype FaceTime
Skype Address: *
Pet Information
Dog's Name *
Age *
Sex *

Male Female
Breed *
Spayed/Neutered *

Yes No
Does your dog have a bite history? *

Yes No
Briefly describe your dog's concerning behavior *
“Dogology” and Christine Surmra cannot guarantee results from behavior consultation recommendations or that my dog will never bite, that my dog will not be dangerous or vicious in the future, that my dog will not exhibit other behavioral problems, or that the results of training will last for any particular amount of time.

Liability:

If my causes property damage, or bites or injures any dog, animal or person during or after the term of the Behavior Consultation, then I agree to pay all resulting losses and damages suffered or incurred and to defend and indemnify “Dogology” and Christine Surma from any resulting claims, demands, lawsuits, losses, costs or expenses, including attorney fees. If my dog is injured in a fight or in any other manner, including death, or sickness it may suffer during or after Behavior Consultation or modification, I assume the risk and agree that “Dogology” and Christine Surma should net be held responsible for any resulting injuries, losses, damages, costs or expenses.
*

I UNDERSTAND AN AGREE TO THE TERMS
No refunds will be issued after receipt of the completed Behavioral History Questionnaire and scheduled appointment.
Virtual Behavior Consultation

60-Minute Consultation $ 100.00

30-Minute Support Consult $ 55.00

Total $ 0.00

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Virtual Phone, Skype or FaceTime Behavior Consultation

Pet Information