Behaviour Questionnaire
The following questionnaire allows me to gather some additional information in advance of the consultation. If you have two or more pets, you can use the same questionnaire.
Your name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Regular vet clinic (please note if they may be under a different name)
Pet's name
Age of pet
Male or female
Male
Female
Unknown
Breed
Occupation of owner(s)
Names of other household members (please include ages of any kids)
Other household pets (including age and breed)
Weight (approximate is fine)
Where did your pet come from? For example, breeder, rescue or pet shop. If rescue please note which rescue organisation
How old was your pet when you got them?
Current problems with your pet (listed in order of importance)
What have you tried to fix the problem (it is okay to say nothing, there are no judgments here!)
What do you do when your pet does something you don't like?
Does your pet have a history of any medical problems or injuries?
Are you using any supplements, gadgets or natural remedies such as Zylkene?
How do you feel about medications for your pet?
What does your pet do when meeting strangers?
What is your pet's favourite treat?
Does your pet have any food sensitivities or allergies?
Have there been any recent household changes that may have impacted your pet?
I sometimes use an AI note taking app to save taking notes during appointments. Are you happy for me to record the consultation?
Yes it is okay to use an AI note taking app
No I am not comfortable with AI
Submit
Should be Empty: