Thank you for booking an appointment with The Veterinary Behavior Center!

Our team is committed to helping you and your pet have a happier and healthier life together. Here you will find important information about working with us and a patient questionnaire. All information provided on these forms is strictly confidential.

We will reach out to your primary care veterinarian directly for medical records.  If you have any notes from a trainer, feel free to email those to info@vetbehaviorcenter.com in advance of your appointment.  

If you have scheduled an appointment for more than one pet in your household, please fill out a form for each pet.

If you have any short videos that demonstrate the behavior problem, click here to upload them.  Never incite or prolong an aggressive or stressful event just for the sake of a video - this could be a bad learning experience for your pet and may be a safety risk. 

Please complete this paperwork at least 3 days before your appointment.

Additional information about our Center, including your financial investment, can be found at www.vetbehaviorcenter.com or feel free to call or email. Please let us know if you have any questions in the time leading up to your appointment.

 We look forward to meeting you and your pet(s)!

 

 

- The Veterinary Behavior Center team

STATEMENT OF MUTUAL UNDERSTANDING

 

Thank you for seeking out the services of The Veterinary Behavior Center, LLC. Living with behavioral disorders in pets can be very stressful, and we are honored that you have trusted us to help you and your family.

 

Reasonable expectations are important when treating behavioral problems. While in some cases we are able to treat elements of a behavioral condition relatively rapidly, the majority of behavioral improvement occurs over time. Behavior change is a process. Allow us to lead you through this process and most pets can show improvements. Your participation in this process, and consistent follow through, is essential for success. While improvements are common with many behavior problems, most behavior problems are not completely curable. For instance, if your pet is growling, snarling, snapping or biting, while we may be able to decrease the frequency and intensity of these behaviors, it is likely that, even with treatment, this behavior will occur at some point to some degree in the future. Our goal is to help you decrease the problem behavior to a level that at the very least you can comfortably live with and maximizes your pet's quality of life. Because each pet is an individual, there can be no guarantee on the results of treatment.

 

You could be held legally and financially responsible for any injuries that your pet causes. And, you alone are responsible for avoiding situations that could result in injury. 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 the course of treatment. 

 

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 are the owner(s) of the animal(s) seeking treatment from The Veterinary Behavior Center, LLC. You acknowledge the risks inherent in owning an animal and accept the liability associated with it. You understand that all fees are to be paid at time of service and you accept full responsibility for fees incurred at The Veterinary Behavior Center, LLC during the diagnosis and treatment of your animal. You also acknowledge that all purchases of treatment packages are nonrefundable and deposits applied toward your appointments will be withheld if you reschedule or cancel with less than 72 hours notice.

 

 

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.  Current Financial Investment is available for review on our website. 
 
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.  
 

5-day Cancellation Window Chart 

Appointment Day	Monday	Tuesday	Wednesday	Thursday	Friday
Cancel by 11:59pm on this preceding day to avoid cancellation fees	Wednesday	Thursday	Friday	Saturday	Sunday

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. 

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. 

Summary chart: 
 

	Financial Investment at Time of Scheduling	Cancellation Prior to 5-day Window	Cancellation within 5-day Window	Late Cancellation Less than 24 Hours or No Show
First Appointments	50% pre-payment due at time of scheduling	Reschedules at no charge; For cancellation, we can refund the 50% pre-payment minus a $20 processing fee OR hold the fee on file for any future service (within 6 months) with no penalty	Initial 50% held as a cancellation fee; another 50% or card on file required to reschedule	Remaining 50% charged out; another 50% or card on file required to reschedule
All subsequent appointments	As long as card is held on file, no fee at time of scheduling; if no card on file 100% of fee charged at time of scheduling	Reschedules and cancellations at no charge, as long as card is on file	50% of fee is charged as cancellation fee OR if for package, 50% of a la carte price is charged.	100% of fee is charged as cancellation fee OR appt in package is consumed.
Vet-to-Vet Partnership  Teleconsult	100% pre-payment at time of scheduling	Reschedules at no charge; cancellations fully reimbursed minus a $20 processing fee or money can be held on file for future service within 6 months.	100% held as cancellation fee – OK to apply fee towards Comprehensive Care services	100% held as late cancellation fee – OK to apply fee towards Comprehensive Care services
Housecall Treatment Appointments	100% of appointment fee is charged at time of scheduling	Reschedules at no charge; cancellations fully reimbursed minus a $20 processing fee or money can be held on file for future service within 6 months.	100% held as cancellation fee	100% + travel fee held as late cancellation 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.   
 
 
Excessive Late 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. 

Please describe the top 3 reasons that you are scheduling with us. If only one reason, feel free to skip sections entitled Behavior Problem #2 and Behavior Problem #3 and proceed directly to General Behavior Information below.  

The Veterinary Behavior Center, LLC utilizes telehealth services as a platform to provide treatment to our patients at a distance. The veterinarian assumes responsibility for making medical judgements and providing recommendations accordingly. Through our telehealth services we are able to perform and assess video/live stream based body language and behavioral assessment, comprehensive intake interview, review of patient medical records and previous diagnostics. We are able to make diagnoses, recommend diagnostics, determine prognosis, prescribe, engage in client education, assist with administrative support and develop and administer full treatment plans. The client understands while there are inherent limitations to telehealth services, including inability to perform physical exams, in person behavioral assessment and undertake certain diagnostics, the veterinarian is making medical judgments to the best of their ability with the provided information and will inform the client on any limitations and additional diagnostics or in-person evaluation needed for best quality of care. The client accepts such recommendations and agrees to follow them to the same extent they would any recommendations received via in person consultation. The veterinarian determines the appropriateness of telehealth services based on individual case and telehealth services may be declined at any time by the veterinarian if it is determined to not be in the best interest of the patient at the veterinarian's sole discretion. The client may decline telehealth services at any time if they choose. To perform telehealth services, clients and patients must be located in the State of Colorado and must be seen in-person at the time of establishing an initial veterinarian-client-patient relationship and at minimum once yearly. By signing this form you consent that you are located in Colorado and understand and agree to how telehealth is used in our practice.

 
**All patients being managed by one of our doctors that have not been seen in person within the past year will be required to do an in-person evaluation in order to continue treatment. This ensures that we abide by the Veterinary Practice Act and is not negotiable.**

The Veterinary Behavior Center, LLC seeks permission to use any recordings, photos and videos for the purposes of diagnosis, treatment planning and monitoring as well as for educational and marketing purposes, including but not limited to lectures, webinars, presentations, printed materials and social media. When used for view in the public, no identifying information will be revealed.

 

Medications may be discussed or recommended in the course of treatment of behavioral problems. Many of the medications prescribed in veterinary behavior have not been approved by the FDA (Food and Drug Administration) for use in all or any animal species for all or any behavior problems. Thus, their use may be considered “off label”. This is a legal, common and well-accepted practice for veterinarians to prescribe medications in this manner. The side effects of off label usage have not been fully studied and regardless, any medication may have unexpected side effects. Not all pets will require the use of medications as part of their treatment, but we want you to be aware of this information in advance. We will make every effort to inform you of potential benefits and side effects of any medications recommended to the extent known. However, you should be aware that different pets may react differently to different medications. We welcome any questions about the use of medications in your pet’s treatment plan. By signing this form you acknowledge that you have received and read this information. Signing this form in no way obligates you to using medications in the treatment of your pet.