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  • Adoption Candidacy Evaluation Report

  • Adoption Candidacy Questionnaire Form

    Please fill out this form to the best of your ability and submit at least 3 days in advance of your Adoption Candidacy Assessment. Utilize the folks on your team who are most knowledgeable regarding the answers to each section so you can provide as accurate and detailed information as possible. We can provide you with the best support when we have all the relevant information. The Veterinary Behavior Center appeciates the opportunity to partner with you as you make adoption decisions for the animals in your care.  We admire your thoughtfulness and committment to best outcomes for pets and people.
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  • Animal Information

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  • Liability Waiver

  • Thank you for seeking services of The Veterinary Behavior Center, LLC.   

     

    This service is designed to assist you in critically thinking about the animals in your care to help you make an informed decision about their disposition and rehoming candidacy.  Ultimately, each organization is responsible for their own decisions.  Recognize the more information we have the better we can support you with a decision, however its impossible for us to have all the information that you do, being that we are not a member of your organization and community and may have never met the animal for which this consultation is designed.  The Veterinary Behavior Center, LLC can never guarantee any outcomes or public safety.

     

    By signing this form The Veterinary Behavior Center, LLC, Dr Ariel Fagen, or any other person employed by or affiliated with The Veterinary Behavior Center, LLC will not be held responsible for any injuries that may happen to you, other people, other animals or your pet during class.  Furthermore, you agree to indemnify and hold The Veterinary Behavior Center, LLC, Dr Ariel Fagen, or any other person employed by or affiliated with The Veterinary Behavior Center, LLC harmless from and against any third-party claims, damages, liabilities, actions, judgments, suits, costs, disbursements and expenses of any kind of nature, including, without limitation, reasonable fees and disbursements of counsel, that may be imposed on, incurred by or asserted or awarded against The Veterinary Behavior Center, LLC, Dr Ariel Fagen, or any other person employed by or affiliated with The Veterinary Behavior Center, LLC in connection with the treatment of your pet.  By signing below you acknowledge the above information.  You acknowledge the risks inherent in owning an animal and accept the liability associated with it.   



     
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  • Cancellation and Card on File Policy

    Effective Wednesday, October 11, 2023.
  • Thank you for partnering with us in the care of your pet. In order to protect everyone’s time and help as many patients as we can, we have enacted this updated cancellation policy. Once you have scheduled an appointment with us it means that we have reserved time in our schedule exclusively for you and your pet. Rebooking these slots after late cancellations can be difficult and there are many patients in our community that are in need of our care.  Please review the following guidelines for financial investment at time of scheduling and cancellation policy based on the type of appointment scheduled.  


    Generally speaking, we have a 5-calendar day Cancellation Window and a 24-hr Late Cancellation window.  How we process payments for cancellations/reschedules will vary depending on whether you do so prior to the 5-day window, between 24 hour and 5 days, or within less than 24 hours/day of. For clarity, here is the preceding day by which we must be informed of a reschedule/cancellation to be considered prior to the 5-day Cancellation Window.  

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  • For your first in-clinic or virtual appointment with us: 

    • 50% of the appointment fee is due at time of booking and you are required to save a card on file. 
    • For those guardians who are unable or unwilling to save a card on file, 100% payment of appointment fee will be due at time of scheduling and refunds will be processed in accordance with the below schedule only. 
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    If a cancellation or reschedule is required, the following policy applies: 

    • Prior to the 5-day cancellation window: Reschedules do not incur any penalty - the initial financial investment can be applied to the rescheduled appointment.  Cancellations are fully refundable minus a $20 processing fee OR the financial investment can be held on file and applied to future services within 6 months with no processing fee deducted.   
    • Within the 5-day Cancellation Window: the 50% fee that was paid is held as a cancellation fee. Another 50% or a card on file would be required to schedule another appointment.
    • Late Cancellation less than 24 hours before the appointment or a No Show: is charged out the remaining 50% to equal the full appointment fee. Another 50% or a card on file would be required to schedule another appointment.  

     

    For all in clinic and virtual follow-up appointments: 

    • Prior to the 5-day cancellation window: no reschedule or cancellation fee as long as card is on file. The $20 processing fee will be applied for cancellations if a card is not held on file. 
    • Within 5-day Cancellation Window: 50% of the appointment fee is charged out at time of cancellation or reschedule. For packages, 50% of the a la carte service is charged out by default. Clients can choose to consume an appointment instead – please let us know if this is your preference.
    • Late cancellation less than 24 hours before the appointment or No Show: the full appointment fee is charged out or a full appointment in a package is consumed.  
       


    Special scheduling: 


    Due to the complex nature of coordinating these appointment types and/or the large chunk of time needed to block out to accommodate them, the following two appointment types have unique policies: 

    • Vet-to-vet Partnership Teleconsults – 100% of the full appointment fee is due at time of scheduling.   If an appointment is cancelled by the client prior to the 5-day Cancellation Window, reimbursement minus the $20 processing fee can be provided or the investment can be held on file for any future service within 6 months.  Within the 5-Day Cancellation Window, a client may elect to cancel the teleconsult and apply those funds towards services within our Comprehensive Care or Behavioral Coaching track at no penalty. The fee will be charged out and a credit placed on your account. Otherwise, all reschedules and cancellations within the 5-day window are considered Late Cancellation and the full appointment fee is charged out. A new fee or card on file would be required for a reschedule. 
    • Housecall appointments - 100% of the fee is due at the time of scheduling. For cancellation or reschedule prior to the 5-day cancellation window, the appointment fee can be held on file and applied to a future appointment or reimbursed minus a $20 processing fee. After the 5-day window, the pre-payment is held as a cancellation fee. Within the 24 hour period the appointment fee + the travel fee are charged out. 
       


    Options to preserve your financial investment and make the most of all our time: 

    • Conversion of an in person to virtual appointment (upon doctor/technician approval pending services that need to be provided)
    • Conversion of all Comprehensive Evaluations to virtual Behavior Intake pending technician availability with remainder of money kept on file going towards future services (expires after 6 months).
    • IF AVAILABLE, take an open slot offered BEFORE the scheduled slot or different time on the same day  
       


    Additional information: 

    • There is no difference in our policy between in person appointments at our clinic vs. virtual appointments. 
    • All charged out fees are non-refundable
    • No refunds are processed for services rendered WITH NO EXCEPTIONS.
    • Reimbursements are always charged the $20 processing fee. 
       

    If you need to cancel or reschedule an appointment, please do so by contacting us as soon as possible.  Leave a message if we do not pick up.   


    Summary Chart:

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  • Excessive Cancellations Policy

    We understand things come up that are sometimes out of our control and want to be as flexible as we can to accommodate these life things.  However, a pattern of late cancellations impacts our ability to care for you, your pet and our other patients.  The first time you cancel within the 24-hour window or no show, you will be charged the cancellation fee as stated above.  If you cancel within the 24-hour window or no show a second time, you will be converted to Pre-Payment Status requiring a 100% pre-payment (or pre-purchased package) at time of scheduling, no exceptions, to continue with our services.  This pre-payment is non-refundable. The full pre-payment will be charged for all cancellations and reschedules within the 5-day Cancellation Window from there on out. For housecalls, more than one cancellation or reschedule within the 5-day window may require us to make the housecall service unavailable. While there is no finite rule about cancellations between the 24-hour mark and the 5-day mark affecting pre-payment status, if a pattern of cancellation is noticed and it effects our ability to provide care to our community, clients may be put into pre-payment status at the discretion of the management team.  Please be mindful of giving us as much advanced notice as possible if a reschedule or cancellation is required.

    Late Arrival Policy

    We are able to accommodate late arrivals to the appointment up to 15 minutes from the appointment start time.  Understand that we will only be able to utilize our scheduled time that has been reserved and that your appointment time, and the content covered, will be truncated to accommodate your late arrival.  Our providers will do the best they can with the time remaining to make forward progress with the case.  All late arrivals are charged the regular appointment fee as the appointment was scheduled – appointments are not pro-rated based on time used.  After the 15-minute mark, it is at the discretion of the provider whether we can still accommodate the appointment or if we need to reschedule and the late cancellation policies will apply.

     

    For Your Security

    All card information is stored directly with our payment processor and undergoes their rigorous privacy protection standards that are PCI Level 1 Data Security Standards compliant.  The Veterinary Behavior Center keeps a token of your card linking the token to their stored information. This means none of our employees have access to actual card information (beyond the last four digits and card type) and protects you against any data breaches of our system.  A hacker would have to hack their highly secure system to reach your card info, not ours.  

     

    Alternative Forms of Payment

    For any given payment, you may elect to use an alternative form of payment such as cash, ACH transfer or check.  Simply provide payment at time of service and your card on file will not be charged.  We cannot accept alternative forms of payment after the fact for services rendered. 


     

    By signing here, you agree to our Cancellation and Card On File Policy, Excessive Cancellation Policy and Late Arrival Policy.  You consent to having your card stored on file to make use of our services or that 100% pre-payment is required with refunds processed only in accordance with the above policy.  You consent to the processing fees, cancellation fees and late cancellation fees that may need to be charged as outlined above.  You understand that all charges for services rendered are non-refundable.  You understand that you may elect to discontinue having your card on file at any time by requesting we delete the card token.  You understand that we aim to be transparent with our billing and that current prices, statements and invoices for all services are always available upon request.  You understand that this policy applies until otherwise informed. 

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  • Organizational Information


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  • Problem Behavior

    Your reason for seeking our services...


  • Medical Information




  • Supplemental Information

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  • Risk Assessment and Prognosis

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  • Recommendations

    For Adoption Candidacy Evaluator to fill out, please leave blank. Note, these recommendations are based upon the information provided above. There may be particulars to your organization, your geographical region, or the individual animal that we are not able to deduce or are not privy to based off this assessment, thus these recommendations are provided as a means to have an objective, outside party assess the circumstance and identify what the perception would be from a skilled behavior professional in the animal welfare industry. This is not a veterinary service. These are recommendations and should not be construed as medical advice, disposition decisions, or a prediction of future behavior.
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