• Initial Behavior History Form

  • PLEASE NOTE: WE MUST RECEIVE THIS FORM AT LEAST 3 BUSINESS DAYS PRIOR TO YOUR APPOINTMENT. WITHOUT IT, WE MAY NEED TO CANCEL YOUR APPOINTMENT AND RESCHEDULE YOU TO ANOTHER DAY.THIS FORM IS IMPERATIVE TO HELP US HELP YOU AND YOUR PET.

    Welcome to Animal Care Center of Castle Pines Veterinary Behavioral Service! We understand how stressful behavioral difficulties in our pets can be, and we are here to help. Our doctors have years of experience treating a wide variety of behavioral concerns – you name it, we’ve likely seen it (many times!) We understand how isolating and scary it can feel to have a pet with behavior concerns, but we are happy to let you know there are many options for treatments to help improve the quality of life for both your pet and your family.


    WE DO NOT NEED TO SEE THE BEHAVIOR TO BELIEVE OR UNDERSTAND WHAT IS HAPPENING!
    We would rather your pet be as relaxed and comfortable as possible as we review the history and treatment plan. Many behavioral diagnoses and assessments are based off verbal history and discussion.

     

    IF A SECTION DOES NOT APPLY TO YOUR PET AT ALL, PLEASE SAY NO TO THE FIRST QUESTION AND SKIP THE REMAINING QUESTIONS IN THAT SECTION.
    IF A SECTION DOES APPLY, BUT IS A MILD CONCERN, PLEASE STILL MARK YES AND ANSWER
    THE SUBSEQUENT QUESTIONS.

     

     

     

  • General Information about pet and household

  • Medical History

  • CURRENT Medications or Supplements

    Please list ALL medications and supplements that your pet is currently and regularly taking– this is not limited to behavior medications or supplements
  • Medication/Supplement 1

  • Medication/Supplement 2

  • Medication/Supplement 3

  • Medication/Supplement 4

  • Medication/Supplement 5

  • TRIALED Medications or Supplements

    Please list ALL medications and supplements that your pet has been on in the past or that you have trialed– this is not limited to behavior medications or supplements
  • Medication/Supplement 1

  • Medication/Supplement 2

  • Medication/Supplement 3

  • Medication/Supplement 4

  • Medication/Supplement 5

  • General Anxiety Screen

  • Cognitive Dysfunction Screen:

  • People Directed Aggression Screen (please note, there will be another section focusing on aggression at the vet clinic or with handling, such as grooming):

    Please note that there will be other sections focusing on aggression towards other dogs/animals and aggression at the vet clinic/handling.
  • Animal Directed Aggression Screen:

  • Separation Anxiety Screen

  • Noise Phobia Screen

  • Fear or Aggression Related to Veterinary Handling or Other Handling (grooming, etc) Screen:

  • Pica (ingesting items other than food and treats) Screen:

  • Compulsive Behavior Screen (tail chasing, light chasing, shadow chasing, self-destructive behaviors):

  • Fear/Phobias Screen (other than those already asked about above):

  • Inappropriate Elimination/Urination Screen

  • Other questions:

  • Did we miss anything?

  • Additional Information:If you have any photos or videos that demonstrate behaviors or concerns that you would like to share, please email them to info@animalcarectr.com – If the file is too large, please mark the photo or video and you can show the doctor at your initial appointment!

  • Should be Empty: