Vet to Vet Online Consult

VETERINARIAN TO VETERINARIAN NEW PATIENT INTAKE FORM
BEFORE YOU START, READ THIS!

Living with a pet with a behavior problem can be stressful. Luckily, you are at the right place to get help.

We know filling out forms isn’t the fun part—but this one is important. The information you share here will give Dr. Radosta everything she needs to create a detailed, personalized plan for your pet.

This is a Vet-to-Vet Online Consult.

You will not meet with Dr. Radosta directly. Instead, she will review your pet’s history, videos, and medical records, then send a full written report to your veterinarian.

What you’ll get
- Your veterinarian will receive a plan that may include behavioral strategies, medical considerations, and medication recommendations (for your veterinarian to prescribe if appropriate).
- Legal note: Florida law requires that only a veterinarian who has physically examined your pet can prescribe medication or make certain medical decisions. Dr. Radosta cannot prescribe directly for your pet during this service.
- Follow-up: Your veterinarian can follow up with Dr. Radosta for questions or for plan adjustments. Our team including Dr. Radosta cannot follow up with you regarding your pets's treatment. All communication will be through your veterinarian.
- If you live in Florida, you can schedule a separate 45-minute Zoom appointment with Dr. Radosta 2–3 weeks later to review progress. This link will be at the bottom of the discharge which is sent to your veterinarian.
- If you do not live in Florida, for extensive plan adjustments, we recommend a follow up online vet to vet consultation in 4 weeks.
Once you’re ready, follow the steps below to complete the form.

How to Complete Your Vet-to-Vet Online Consult Form
1. Fill out the consult history form as completely as possible.
  Upload 2–4 short videos of your pet (total length no more than 4 minutes) using the link at the bottom of the form.
2. Upload your pet’s medical records to the form.
3. If you don’t have them on hand, call your veterinarian and ask them to email them to vetbehavior911@gmail.com.
4. Pay for your consultation directly through the history form (Cost: $300).
5. Avoid sending extra documents such as training reports or additional written histories—this form is designed to gather exactly what Dr. Radosta needs to create your pet’s plan.
6. Once we receive your form, videos, medical records, and payment, Dr. Radosta will create a custom behavioral, medical, and (if appropriate) medication recommendation plan and send it to your veterinarian within 2 business days (Monday–Thursday).
7. Email us with any questions: vetbehavior911@gmail.com
I have read the above and understand*

Yes
HOSPITAL AND VETERINARIAN INFORMATION
Hospital*
Referring Doctor*
Best email for Doctor/Hospital*
Best Phone Number for Doctor/Hospital*

Area CodePhone Number
FAMILY AND PET INFORMATION
Your Name*

First NameLast Name
Your Email*
example@example.com
Your pet's name*
Species*

CanineFelineAvian
Weight in pounds*
Breed*
Birthdate*

MonthDayYear
Date
Gender Status*

Male intactMale neuteredFemale intactFemale spayed
My pet's family is made up of (check all that apply)*

AdultsChildren under 5 years oldElderlyChildren between 5 and 13Children 13-20Children who visit regularly

Presenting Compliants

	Age of onset	Frequency
Aggression
Anxiety
Fear
Fly Snapping
Elimination in the house
Leash Reactivity
Litterbox issues
Noise phobia
Separation anxiety
Storm/Noise phobia
Tail chasing
Run in circles

WHY ARE YOU SEEKING HELP FOR YOUR PET?
List the TWO most important problems to be addressed. There may be more problems about which you are concerned, but we can't treat all problems at once so let's focus on the top two for your famliy.
AGGRESSION

(BARKING, BITING, SNARLING, SNAPPING, BARING TEETH...)

If your pet exhibits aggression please fill out this section. If not, go to the next section.
How old was your pet when you first noticed the aggression?

Before 1 year1-3 years3-7 years8+ years
When does your dog get aggressive? Check all that apply.

BathedBrushedSees bikesCollar taken off/put onCorrectedEatingEyes wipedExamined by veterinarianGroomed (professional groomer)Has a boneHas foodHuggedIn carIn his bedIn your bedIn the houseItem is droppedOn walksIn the yardLeash put on/taken offLiftedLooked atNails trimmedPlayingPushed/pulledReached forSpoken toTouchedSees kidsSees/hears motorcycleSleepingWhen startledToweledOther
How many times has your pet bitten even if the skin was not broken?

1-23-5>5
Who is your dog aggressive toward? Check all that apply.

Adults in my familyAdults outside of my family entering my home or yardAdults outside of my family, on walks or when not at homeChildren in my familyChildren outside of my family entering my home or yardChildren outside of my family, on walks or when not at homeFamliy dogs (living in the same house)Family catDogs not in my famliy, off of my propertyGroomerVeterinarianSkateboardsMotorcyclesBikesWild animalsGolf cartsOther
What does your pet do when aggressive? Check all that apply

Bare teethBarkBite (mouth contacts victim, no broken skin)Bite (mouth contacts victim, skin broken)ClawDilated pupilsEars backGlassy eyedGrowlHead downHair up on back (piloerect)HissLick lipsLower bodyLungePantRear up on hind legsScratchSnapping-Opening and closing of mouth, no contact to victimStiff bodySwatTense musclesTail over backTuck tailTurn head awayTry to get awayWag tailYawnZones outOther
STORMS/SOUNDS

If your pet exhibits fear or anxiety during storms or loud noises please fill out this section. If not, go to the next section.
How old was your pet when you first noticed the fear of sounds?

Before 1 year1-3 years3-7 years8+ years
Triggers Check all that apply.

Electronic beepingConstructionThunderLarge truck soundsFood sizzling in a panText alert soundOther
What does your pet do when there are scary sounds? Check all that apply.

Acts aggressively if you try to move himBarksComes to find youDestructiveHowlsHypersalivates (drools)PantsPacesTremblesOther
How quickly does your pet go back to feeling calm after sound events? Check all that apply.

Immediately10 minutes10-20 minutes20-30 minutes30-40 minutes40-50 minutes50-60 minutes1-3 hours3-6 hours6-12 hours12-24 hoursGreater than one dayOther
DISTRESS WHEN SEPARATED FROM YOU

If your pet exhibits anxiety or distress when left alone please fill out this section. If not, go to the next section.
How old was your pet when you first noticed that your pet was stressed when alone?

Before 1 year1-3 years3-7 years8+ years
T

YesNo
What does your pet do when separated? Check all that apply.

Attempts to find personBarksClimbing on top of furnitureDefecationDepressionDestructionDoesn't eat when you are awayDoesn't eat for minutes, hours or days after you are awayHideHowlHypersalivationPacePantReluctance to eatTrembleUrinateVomitWhineOther
Let us know when your pet is distressed about your departures. Check all that apply.

Separated from you while you are in the house (baby gate, room)Separated from you when you are outside and the pet can see youWhen you are gone, and the pet is completely aloneWhen one particular person leaves even if there is someone home with themPet is not distressed as long as there is another pet with themPet is distressed every single time that they are alone without exception.Pet is distressed intermittently meaning sometimes they're upset when they're completely alone and sometimes they aren't.Pet is not distressed if there is someone home with themPet is distressed anytime they are confined without you such as in a room with a closed door or behind a baby gate.Pet likes their crate and can be confined when you are not home.Pet likes their crate and can be confined when you are home but not when you are not home.Other
Does the patient exhibit the behavior only when alone?

YesNo
OTHER BEHAVIORS

If your pet exhibits any of the behaviors below, please fill out this section. If not, go to the next section.
How old was your pet when you first noticed the behavior?

Before 1 year1-3 years3-7 years8+ years
Displacement/compulsive

Attacking their tailChasing their tailPouncing on or chasing shadows or lightsEating things that aren't food (rocks, fabric)Snapping at things in the air that aren't thereOther
How often do these behaviors happen?

DailyWeeklyMonthlyRarely
URINATION OR DEFECATION IN THE HOUSE (DOGS ONLY)

If your pet exhibits any of the behaviors below, please fill out this section. If not, go to the next section.
Urination/Defecation in the house

My dog was at one time housetrained (didn't urinate or defecate in the house unless ill)My dog is trained to urinate/defecate on pee pads and doesn't go outside to urinate/defecate.My dog has accidents when in the crate.My dog is trained to urinate/defecate on pee pads and outside.My dog has accidents when I am home and when he is alone.My dog is trying to urinate/defecate on pee pads, outside, and also in other places (pet potty).My dog only has accidents during storms or when he is scared.My dog has urine accidents in the house..My dog has defecation accidents in the houseMy dog only has accidents when he is completley alone.Other
URINATION OR DEFECATION IN THE HOUSE (CATS ONLY)

If your pet exhibits any of the behaviors below, please fill out this section. If not, go to the next section.
Elimination behavior (check all that apply)

Urination outside of the litterboxLarge amountsVertical surfacesSmall amountsHorizontal surfacesStanding to urinate with tail twitchingCurved body postureMeows when leaves boxTries to cover in boxTries to cover outside of boxLarge amounts of feces outside of the boxSmall amounts of feces outside of the boxPatient doesn't exhibit any of the above clinical signsUnknownOther
Situations (check all that apply)

Owner is homeOwner is not homeSoft surfacesHard surfacesHigh surfacesLow surfacesOther
Number of cats in household
Number of litterboxes in household
Type of litter
How often do you scoop the box?
How often do you scoop the box?

When I notice it is dirtyOnce a dayTwice a dayThree times a dayMore than three times a day
List any additional problems that you would like addressed.
YOUR PET'S HEALTH

Changes in health have a major impact on behavioral clinical signs. Make sure to check all that apply and use the "other" field if necessary.
Has your pet has any of these changes in the past 6 months?*

Changes in appetiteConstipationDiarrheaDifficulty urinatingPain when urinatingUrinating small amountsUrinating large amountsUrinary tract infectionsIncreased urinationUrinary incontinenceAllergiesEar infectionItchinessSkin infectionMuscle wastingOrthopedic pain or arthritisNeurologic painWeight gainWeight lossDiabetesHypothyroidismAddison's disease (hypoderenocorticism)Cushing's diseas (hyperadrenocorticism)Increased thirstNone of the aboveOther
Current Medications. List all medications, the current dose and how often you give it, even if they are not "behavior" medications. *
Medical history. Please list any additional clinical signs/diseases/disorders not listed above
Briefly share anything else that you think the doctor should know.

0/150
***PLEASE DON'T SKIP THIS STEP***

The videos allow Dr. Radosta to see your pet in their home environment. This is extremely important as a diagnosis and treatment plan should not be made on the history alone, but also on observation.

Upload 2-4 videos (total of no more than 4 minutes of video) and medical record below.

Do not endanger your pet or yourself making videos! Do not provoke the behavior.

Helpful videos can include:

1. The environment (home, yard, car)

2. Your pet interacting with you or others.

3. Your pet during a stressful situation as long as it is safe (storms, when you are gone, in the car, when visitors come over).

If you would like a separate link for the videos you can submit them directly instead of dropping them into this form at this link:

Drop Videos Here
Dr. Radosta completes consult Monday through Thursday from 9 AM to 5 PM. She will start the consult when all medical records (see below) and at least one video have been submitted. If you will be submitting more videos or records, please let us know by email so that we can hold the consult until you are ready for her to complete it. Otherwise, as soon as all medical records and at least one video is received it will be sent to her and she'll start the consult as long as it's within the timeframe above. Don't hesitate to reach out to us if you have any questions.
Dr. Radosta teaches veterinary healthcare team members, pet parents and dog trainers on the behavior of animals. We would like permission to use those videos for any lawful purpose, including, but not limited to, website, social media accounts, and promotional materials, either digital or in print, in perpetuity. By selecting yes, below, I authorize Dr. Radosta to edit, alter, share, remix, tweak, build upon or in any way alter the photographs or videos mentioned above. I also waive any rights of privacy or compensation associated with the use of my or my pet’s image(s) and name(s) for the personal or commercial purposes outlined above.*

Yes, I consentNo
SUBMIT MEDICAL RECORDS AND VIDEOS HERE. This form will not submit without at least one attachment. All medical records should be in PDF form. Send the full medical record with doctor's notes and any results from diagnostic testing. Invoices do not tell the full story of your pet's health. If you don't have these records. call your veterinarian and ask them to send them to us at vetbe I wonder whyhavior911@gmail.com.*

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Pay for your consult here.

Full Veterinarian to Veterinarian Telehealth Consultation $300.00

What you get: A 2-4 page report with an assessment of your patient's behavior; differential diagnosis list; initial medication, management and safety and behavior modification plan. Follow up questions regarding the initial consultation via email (vetbehavior911@gmail.com) for up to 14 days after the consult is returned to you at no additional cost.

Total $0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

I acknowledge that my primary care veterinarian, whom I have listed above, is my treating veterinarian. This diagnostic intake doesn't establish a veterinarian-client-patient relationship as mandated by federal or state law. As such, Dr. Radosta cannot recommend a medication for my pet directly to me in writing or in any other way. Instead all treatment instructions will be sent to my veterinarian who will then send them to me and will prescribe all medications.

I am the owner(s) of the animal(s) seeking behavioral medicine treatment through an online consult with Dr. Radosta. Behavioral treatment, training and advice when properly maintained after completion can be very helpful in resolving problem behaviors in animals. Because each pet is an individual, no guarantee or assurance can be made as to the results that may be obtained. Animal behavior including aggression is unpredictable and will remain unpredictable after its treatment. Dr. Radosta cannot promise that the animal's treatment, training or advice will eliminate the animal's potential danger to persons or completely control the animal's aggressiveness. Animals should be closely supervised particularly around children and infants and should be controlled at all times including conformance with local ordinances and "leash laws."

I am bringing my pet to this appointment with a full knowledge of these risks and understand and accept the liability that is inherent in owning a pet who has shown aggressive behavior.
I have read the above statement, acknowledge it and agree to what is written there. Signature (Use your track pad and sign with your finger or use your mouse)*

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VETERINARIAN TO VETERINARIAN NEW PATIENT INTAKE FORM