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Two steps are required.  Thank you for your patience. 

Step 1:  Please complete and submit the information below.  Items in RED are required.

Step 2:  Pay.     PayPal               




First Name
Last Name
Street Address
Address (cont.)
Zip/Postal Code
Work Phone
Home Phone

What would you

to talk about ?

Dog's Name    Dog's Age Dog's Breed(s)?
What is the Name of your Veterinary Clinic?

 How did you find out about Canine Learning Center? 

The following information is optional, but may help save time during our phone consultation.  If you do not wish to fill this portion out, please skip down to our policies.

Is your dog spayed or neutered? If so, at what age was this done?

Where did you acquire your dog?

How old was our dog when you got him/her?

Do you have a fenced in yard? 

How does your dog get his/her exercise?


Where does your dog stay during the day when you are home?

during the day when you are not home?

at night during waking hours?

while you are sleeping?

Is your dog trained to a crate?

How many in your family?

If there are children, please list their ages:

Do you have other pets?  

Please list:

What brand of dog food do you feed your dog?

Policies and Procedures:

1.     Toll callers will be responsible for long distance charges and you will be asked to call me at a designated phone number.

2.    Your appointment begins at the designated appointment time whether or not you are there when I call (or in the case of long distance, if you do not call on time).  If you are not there, I will continue to call every five minutes for the first fifteen minutes only.  The missed time cannot be made up (it is not fair to the next appointment following yours).  For example, if you are 5 minutes late with your call, you will lose that time but still be responsible for the full charge for your scheduled time.

3.     If there is a problem on my end that delays the call, you will not be penalized and you will receive your allotted time in full.

4.    You can cancel your appointment for a full refund as long as we are notified by the last business day (M-F 10-4 pm) prior to your appointment.  Cancellations the same day receive credit only towards a new telephone consultation and cannot be issued a refund.  If I need to reschedule on short notice, you will receive your rescheduled consultation for half price.

5.     Cost: 30 minutes - $15 (min. charge),/   60 minutes - $25

6.    If there are unused minutes (over the 30 minute minimum), you will receive a refund $2 for every  5 minutes not used. Refunds are for unused minutes only.  

I agree with the above policies

All rights reserved.
Revised: August 30, 2009