Behavior Consult Form

Behavior Consultation Form

To be filled out ONLY once your pet has a confirmed appointment time.
To prevent any confusion, we want to be very clear that BYVH veterinarians are NOT Veterinary Behaviorists. They are veterinarians who have a passion for animal behavior and enjoy working with clients and patients to support our community of positive reinforcement trainers when behavioral medications are deemed necessary for progress.

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 or are working with a trainer who employs aversive methods and are not open to alternative methods of training, we are likely not a good fit for you based on behavior philosophies.
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...
- Canine Patient Information
- Patient name
- Patient breed
- Age
  Approximate age or birth date if known
- Patient is a
- Appointment Date
  
  MonthDayYear
  Date
- Appointment Type:
- For phone consults, who should we contact? Please list name + number:
- 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, please do NOT fill this out! Please call us to discuss next steps):
- How long have you had your pet and how old were they when you obtained them? Where did you obtain them from (breeder, rescue, etc.)? Do you know anything about their prior history before they came to your home?
- 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.
- 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.).
- Are you currently working with a trainer? Please list the name of the trainers/training facilities and how long have you been working with them.
  If a veterinary professional or trainer referred you, we'd love to thank them!
- What training equipment are you currently utilizing?
  For example: head collar, harness, etc
- Does you 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.
- Please list your pet's daily activity and exercise routine
- 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)?
- 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?
- Has your pet ever bitten another person or dog. If yes, please described the severity of the wound and the context of the situation. Please be specific.
- To assess bite levels, click to populate/unpopulate informational image
- 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 BYVH veterinarians are not board-certified veterinary behaviorists but are comfortable in counseling owners about options for medication and training options using the latest scientific 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
- Name
  
  First NameLast Name
- Date
  
  MonthDayYear
  Date
- Please upload any files or pertinent medical records
  
  Browse Files
  
  Cancelof
- 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
- Appointment Date
  
  MonthDayYear
  Date
- Appointment Type:
- 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):
- 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
- 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