• Behavioral Consultation Intake Form

    This form helps us better understand your pet's medical history, daily routine, environment, behavioral concerns, and household goals prior to your appointment. Please answer all questions as thoroughly and honestly as possible. If available, please submit videos of the behavior concern prior to your appointment. The consultation will consider veterinary and behavioral factors, including medical conditions, pain, stress, learning history, and environmental factors.

  • Owner Information

  • Format: (000) 000-0000.
  • Preferred Contact Method*

  • Dog Information

  • Medical History- Check all that apply
  • Veterinarian Visit Within Past 12 Months*
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  • History of Biting

  • Behavioral Information

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  • Most challenging situations*
  • How often does the behavior occur?*
  • Have these behaviors worsened over time?*
  • Does your pet show any of these stress or overwhelm responses
  • Have you previously worked with a trainer, behavior consultant, or veterinary behavior professional?
  • What training tools/equipment are currently used? (Check all that apply)
  • What motivates your dog most? (Check all that apply)

  • Goals & Expectations

  • How much time can your household realistically dedicate to training and management each week?
  • Are you interested in:

  • Policies & Acknowledgement

  • Companion Animal Hospital's Behavioral Health Consultation is a collaborative service provided by Dr. Taylor McCain, DVM, and Mackenzie Duplechin, FFCP, Trainer & Behavior Consultant.

    Your initial consultation includes:

    • Review of completed intake forms and medical history
    • Review of submitted photos and videos (when provided)
    • Comprehensive discussion of behavioral concerns and household goals
    • Veterinary examination and medical assessment by Dr. McCain
    • Behavioral history review, assessment, and observation by Mackenzie
    • Collaborative case discussion between veterinary and behavioral professionals
    • Identification of potential medical, environmental, and behavioral contributing factors
    • Individualized treatment recommendations
    • Written behavior and management plan
    • Recommendations for training, behavior modification, environmental changes, enrichment, medication, diagnostics, or referrals as appropriate

    Consultation Fees:
    • Veterinary Behavioral Evaluation (Dr. McCain): $69
    • Behavioral Consultation (Mackenzie Duplechin): $175

    Additional fees may apply for recommended diagnostics, laboratory testing, medications, supplements, follow-up appointments, training services, behavior modification coaching, referrals, or other treatments deemed necessary based on your pet's individual needs. An estimate can be provided after the initial exam.

    Behavior change is a gradual process that varies significantly between individual animals. Progress may be influenced by medical conditions, genetics, environment, learning history, stress levels, management practices, and consistency of implementation. While individualized recommendations and treatment options will be provided, specific behavioral outcomes cannot be guaranteed.

     

    I understand that behavior concerns may have both medical and behavioral components, and that recommendations may include diagnostics, medication, behavior modification, management strategies, training, environmental modifications, or referral to additional professionals as appropriate.

    By signing below, I acknowledge that I understand the consultation fees and services listed above, that additional charges may apply for diagnostics, treatment, medications, training, or follow-up services, and that behavior treatment is an ongoing process requiring active participation and follow-through.

  • If you were unable to upload documents, video or pictures using the form, please send to:

    info@myk9genius.com

    or to:
    (985) 320-5266

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