• VETERINARIAN TO VETERINARIAN NEW PATIENT INTAKE FORM

    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

  • HOSPITAL AND VETERINARIAN INFORMATION

  •  -

  • FAMILY AND PET INFORMATION

  • Species*
  • Birthdate*
     / /
  • Gender Status*
  • My pet's family is made up of (check all that apply)*
  • Rows

  • WHY ARE YOU SEEKING HELP FOR YOUR PET?

  • 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?
  • When does your dog get aggressive? Check all that apply.

  • How many times has your pet bitten even if the skin was not broken?
  • Who is your dog aggressive toward? Check all that apply.

  • What does your pet do when aggressive? Check all that apply

  • 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?
  • Triggers Check all that apply.

  • What does your pet do when there are scary sounds? Check all that apply.

  • How quickly does your pet go back to feeling calm after sound events? Check all that apply.

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

  • Let us know when your pet is distressed about your departures. Check all that apply.

  • Does the patient exhibit the behavior only when alone?

  • 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?
  • Displacement/compulsive

  • How often do these behaviors happen?

  • 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

  • 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)

  • Situations (check all that apply)

  • How often do you scoop the box?

  • 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?*

  • 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.*
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  • Pay for your consult here.

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    • 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.

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