Separation Anxiety Intake
SA Program Intake Form
This form gathers detailed information specific to your dog's separation anxiety. The information helps me assess the severity, identify contributing factors, and design an effective treatment protocol.
Please plan to spend about 30 minutes completing this form.
Pet health insurance
If you have pet health insurance, please check to see if they cover behavior services provided by Certified Applied Animal Behaviorists. You may be eligible for reimbursement of a portion of your costs.
Having trouble with the form? Contact me directly:
You will receive a confirmation email on successful submission of your form.
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© 2026 Nutz About Mutz · Jody Epstein, MS, ACAAB, CDBC, FFCP · Board-Certified Applied Animal Behaviorist