Behavioral Consult History Form

We want to partner with you in the care of your pet! For the appointment to be as successful as possible, getting a detailed history of your pet's behavior is important. Please fill out the following brief questionnaire about your concerns - they'll show us where we can help. Please call our office at 616-949-0960 to schedule your consultation and submit this form before your appointment.

Name

Primary Phone

Email Address

Pet's name

Is your pet a: Dog Cat

What medication(s) is your pet currently taking? (Please list name of medication, milligrams, and frequency)

Any history of reactions to any medications or supplements? If yes, please explain.

At what age did you obtain your pet?

Please describe the behavior problem(s) you are seeing.

How often are you seeing these behaviors and have you identified any possible triggers?

When did the behavior problem(s) start?

How old was your pet when the behavior problem(s) started?

Any history of biting people or other animals? If so, what was the circumstance?

What interventions have been tried so far and what was the outcome?

Are you currently working with a trainer? If so, who are you working with and when is your next session?

Has rehoming your pet ever been discussed or considered? Yes No

Please list all members of the household (including other pets), their ages, and their relationship with your pet:

What goals do you have for this appointment?

Please verify