Behavior Consult Form

Behavior Consultation Form
To prevent any confusion, we want to be very clear that Dr. Phelps and Dr. Hooper are NOT Veterinary Behaviorists. They are exceptional veterinarians who have a passion for animal behavior and enjoy working with clients and patients in conjunction with positive reinforcement trainers.

If you are seeking guidance from a Board Certified Veterinary Behaviorist, please visit our website for more information.

Aversive training collars or tools are not allowed inside our clinic (prong collar, e-collar, etc) as we only recommend positive reinforcement training methods. If you prefer to utilize "balanced" training and aversive methods, we are likely not a good fit for you.
Your name*
Primary person on the account
Your email*
Primary person on the account
Your phone number*
Primary person on the account
PATIENT DETAILS
My pet is a...*

CatDog

FELINE Behavior Form
Feline Patient Information
Patient name*
Patient breed*
Ex. Domestic short hair, Tabby, Siamese etc.
Age*
Approximate age or birth date if known
Patient is a*

Spayed FemaleNeutered MaleIntact FemaleIntact Male
Appointment Date*

MonthDayYear
Date
Appointment Type:*

In clinicPhone consult (only available on a case by case basis to established clients)
For phone consults, who should we contact? Please list name + number:
How long have you had your pet? From where did you obtain them and what was their age at that time?*
Please list ALL previous veterinary clinics that your pet has been seen at. Including full name of clinic and location. We will need to obtain previous records BEFORE your appointment*
Previous medical/behavior history is crucial to your appointment.
Due to the in-depth and long term management involved, we only provide behavior consults for established clients or those who are transferring their pet's full veterinary care to BYVH. We do NOT accept new patients who are receiving their regular veterinary care elsewhere. Please select an option below so we can confirm you have read and understood (if you are not transferring care, we will call you to discuss other options):*

I am an established client of BYVHI am transferring veterinary care for my pet to BYVHI am NOT transferring regular veterinary care for my pet to BYVH
In DETAIL, please describe the behaviors you would like to address (please be as specific as possible, such as how long this has been happening, triggers, etc.). *
What have you tried previously to help alleviate the issue(s)? Any significant positive or negative results?*
Please describe your current litterbox set up*
*Or let us know if your cat uses the bathroom outside
Briefly describe your cats daily routine (meal times, outside time, favorite sleeping spots).*
Please explain your cats' favorite enrichment activites and/or items:*
Have there been any recent (in the last 6-12 months) stressful events or life changes that have occurred?*
How many other animals are in the household? Please list species and ages.*
How many other adult humans are in the household? Any children? (please list ages)?*
Does your pet have any pertinent medical history or physical issues that you may believe could be affecting their behavior?*
Please list ALL medications that your pet is taking. This includes supplements, parasite prevention, current behavior medications, CBD, etc.*
Has your pet ever had an adverse reaction to a medication? Please list medication and what was observed.*
Have you used medication before to address any behavioral issues? Please list any observations about impact of medications.*
Do you have specific questions you would like to address at this appointment?*
What are your goals for your pet?*
Have you ever thought about rehoming your pet?*
Is there anything else we should know?*
Has it been advised that you seek the input of a Board Certified Veterinary Behaviorist (Diplomate of the American College of Veterinary Behavior - DACVB)*
Portland Oregon has two facilities that offer the services of these specialists: Animal Behavior Clinic/Instinct and Synergy Behavior Solutions.
If you selected YES to the above question, have you made a consultation with one of the facilities listed above or what is preventing you from seeking help from a Board Certified Veterinary Behaviorist?
By signing below, I understand that Dr. Phelps and Dr. Hooper are not board-certified veterinary behaviorists but are comfortable in counseling owners about options for medication and training options using the latest scientific training recommendations. I understand that in certain cases a referral to a board-certified veterinary behaviorist may be in my pet's best interest.

The veterinarian may discuss and/or recommend the use of medication(s) as part of your pet’s comprehensive treatment plan. Many of the medications that are prescribed for the treatment of behavioral problems are not expressly approved by the FDA (Food and Drug Administration) for all or any animal species and their use is considered “off label”. This is a legal and well-accepted practice for veterinarians to prescribe medications in this manner.

We assure you that we will make every effort to inform you of the benefits and potential side effects of any medications recommended.
Signature*

Clear
Name

First NameLast Name
Date

MonthDayYear
Date
Please upload any files or pertinent medical records

Browse Files

Cancelof
Should be Empty:

Behavior Consultation Form

PATIENT DETAILS

Canine Patient Information

Feline Patient Information