For your review. A printed copy will be presented at the first session for your signature.You may print this for your records if you wish.

Client Refusal to Authorize and/or Pay for Recommended Behavior Modification
or Veterinary Behaviorist Referral
Zippity Do Dog Training and Behavior Modification Trainer: Lee Desmarais

Client’s name                                                                                              
 
Name of Dog                                                                                               
 
Breed                                                                                                          
 
_____ I, the undersigned owner of the dog(s) identified above, being 18 years of age or older, am authorized to make decisions regarding its case.
 
_____ I hereby acknowledge that my trainer, Zippity Do Dog Training and Behavior Modification and Lee Desmarais, has recommended or offered management options, behavior modification and/or referral to a veterinary behaviorist for my pet’s handling-related or behavior-related issues.
 
I decline these recommendations (circle the ones offered that you decline)

• Management In Home and/or In Public (e.g. barriers, basket muzzles, etc)
• Behavior Modification
• Veterinary Behaviorist Referral

 
_____ I understand my pet is showing aggressive tendencies (including, but not limited to: resource guarding, fear-aggression, or status-related aggression) and behavior displays including, but not limited to: cowering, trying to escape, growling, showing teeth, snarling, fixated focus, snapping, lunging, biting and other stress related behaviors.
 
____ I understand that by declining the above recommended services the current behavior issues are likely to escalate and a major bite incident may occur.
 
_____ Continued opportunity to practice escalating aggressive behaviors (e.g. growls, barks, fixated focus, lunges, snaps, bites) will raise my dog’s base line arousal for such behavior, causing her/him to trigger more easily and become more aggressive, possibly without warning prior to a bite.
 
_____ I agree to hold Zippity Do Dog Training and Behavior Modification and Lee Desmarais harmless for any adverse behavioral effects that result from declining these services.
 
_____ I agree that I, the legal guardian of the above named dog(s), shall be held solely and completely financially responsible for any damage or injury to a human, another animal or property that incurs a cost to repair.
 
 
 
   _________________________________________________                   _________
            Signature of Owner or Authorized Agent                                             Date