Behavior Consultation Form

Behavior Consultation Form
Client Information
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
How did you hear about us?
When is your appointment?
Date

Month Day Year
Date
Time
Pet Information
Pet Name
Date of Birth
Species

Canine Feline Other
Breed
Color
Sex

Male Female
Spayed/Neutered?

Yes No
Is your pet currently up to date on preventative healthcare (i.e. vaccines)?

Yes No Unknown
Is your pet microchipped?

Yes No Unknown
Microchip Number
Where did you get your pet? At what age?
Has your pet had any previous owners that you know of?
If your pet is not a current patient of ours, please answer the following questions:
Where has your pet been receiving veterinary care?
If your pet is a cat, have they been declawed? At what age?
When was the last time your pet's bloodwork was checked?
In the past, has your vet told you that your pet does better with you in or out of the room?
Does your pet have any known medical conditions?
Please list all current medications and supplements:
Please describe your pet's problem(s):
Please give a brief description of all undesired behavior(s) or problems:
At what age did the problem(s) begin, if known?
Has there been any changes in the behavior(s) over time?
Are there any specific situations that seem to trigger the behavior(s)?
What people and pets live in your home? Are the undesired behaviors directed towards any of them in particular?
Are you able to stop the behavior(s) while it's happening? If so, how?
Have you noticed any of these behaviors in your pet?

Licking lips Cowering Lunging Yawning (when not sleepy) Barking Snapping Tail tucking Growling Biting Turning away/trying to hide Lifting lip Other
Please describe your pet's typical day, from waking up to bedtime:
Please list any previous behavior medication that has been tried, and what were the results?
Have you attended behavior classes or seen a behaviorist or trainer with your pet? If so, please describe the training/intervention and any outcomes:
Has training worked for your pet so far?
What is your pet's preferred reward? i.e. treats, table food, toys, affection, etc.
Does your pet(s) have any food allergies or sensitivities? If so, please list:
If your pet is a dog, what type of collar(s)/harness(es) do you use?

Martingale Head halter Flat collar Body harness Choke collar Electric collar Prong collar
What are your goals for this consultation?
What you can expect at your visit

**DUE TO COVID WE ARE CURRENTLY CURBSIDE SERVICE ONLY**That means you can remain in the comfort of your car while we care for your pet! When you arrive, park in a numbered spot and call the phone number listed. Once your doctor and technician are ready for your pet, they'll call you and meet you at our front door. The doctor will call you to discuss all of your pet's needs and lifestyle. You will have the opportunity to ask any questions you want! We can email you an estimate for your pet's care so you can have a visual of what the plan for the day will be! Please also keep in mind that phone call volume has increased exponentially so it might take a few minutes longer than normal! We appreciate your understanding and patience while we navigate these tough times! Please have any previous medical records sent to frontdeskgreenfield@gmail.com prior to your appointment time. Videos of behaviors may be helpful. If you have any, please text them to (248) 356-1100 or email them to frontdeskgreenfield@gmail.com. (DO NOT INVITE OR TRIGGER AGGRESSIVE BEHAVIOR FOR THE PURPOSE OF THE VIDEO!)
Communication

We utilize your email and cell phone number to communicate your pet's health and appointment reminders conveniently through our app, PetDesk! The PetDesk app allows you to text us, request appointments, medication refills, and view your pet's health reminders. Download the app today!
Fees and Payment

Fees for all care is due at the time of service and are non-refundable.*We accept all credit cards and cash, sorry, *no checks please!* Need financing? Our staff can help you apply for Care Credit or ScratchPay which offer interest free financing. We believe in an open and honest discussion of your pet's charges. A treatment plan with cost can be provided, just ask!
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