Behavioral History Your First Name: * Last: * Pet’s Name: * Email: * Phone: * Species: Dog Cat Ferret Other Are behavior issues the PRIMARY reason for this consult? * Yes No Note: behavior issues often require extended consultation and addressing them at this consult will be limited to how they may be relevant to the primary concern. If there are behavior issues you’d like to address in greater depth, an additional consult will be needed at another time. We can also recommend a behavioral specialist for advanced issues. Behavior History: Basic Is your pet afraid of: Fireworks Storms Loud noises in general New Animals New People OtherOther Do they exhibit ABNORMAL levels of distress or excitement in response to any of the following: Owner leaving/being left alone Owner returning (extreme excitement’) Being separated from certain household members OtherOther Are they protective or aggressive around: Food Toys Certain People OtherOther Do you feel they display either excessive excitement or any degree of aggression in response to: New People / Strangers Other Animals Doorbells/knocking OtherOther Please elaborate on the above, and any other behavior concerns: * Behavior History: General Have they been seen at AVC for behavior issues previously? * Yes No This is a follow-up on a recent (<6w) visit for this specific problem Our behavior history is designed to be thorough and identify issues you may not be aware of. If this is your first time filling it out, please be as thorough as possible – the time spent will help us help you! Please be complete with your answers (include issues we’ve discussed previously), but for any written questions focus on what is new or different since your last Consult if we have discussed them previously In just a few words, what is your PRIMARY behavior concern for this Consult? * How have the behavior issues changed since the last visit? * Much improved Improved About the same Worse Other/Explain:Other/Explain: When did the behavior issues start? * Is your pet afraid of: Fireworks Storms Loud noises in general New Animals New People OtherOther Describe the behaviors they exhibit in these situations which you interpret as fear: * How severe would you say their fear is in these situations? * 6 10 = severe fear Do they exhibit ABNORMAL levels of distress or excitement in response to any of the following: Owner leaving/being left alone Owner returning (extreme excitement’) Being separated from certain household members OtherOther Have they been destructive when left alone, or are you afraid they may hurt themselves? Yes No Describe what they do in these situations (specific behaviors) that you interpret as abnormal distress or excitement: How severe do you feel their distress is when separated? 5 10 = severely distressed Are they protective or aggressive around: Food Toys Certain People OtherOther What specific protective or aggressive behaviors do they display? Have they ever bitten or otherwise injured anyone in these situations? If so, explain: How concerned are you about these PROTECTIVE or AGGRESSIVE behaviors currently? 5 Do you feel they display either excessive excitement or any degree of aggression in response to: New People / Strangers Other Animals Doorbells/knocking OtherOther How do they typically respond to strangers or new people? Are you worried your pet may injure another person or animal? Yes No Maybe My pet has caused injuries Are there young children or other housemates that might regularly pay UNWANTED attention to the pet? * ChooseYesNoMaybe/not sure Please elaborate: In the time since the behavior concerns started, and immediately proceeding, have there been any major changes in the environment/schedules/daily routine such as: New housemates (people/animals) Departed housemates (people/animals) Schedule changes Moving homes Home renovations/repairs OtherOther Add any details about the changes that might be of interest: Does your pet engage in any other behaviors you find unusual, abnormal, or concerning? * Yes No Please elaborate in as much detail as possible (you may also add a short video at the end) * Any additional info regarding your pet’s behavior for the Veterinarian? Previous Behavior History Has your pet ever worked with a trainer or behaviorist for: General obedience/training Socialization Specific behavior concerns OtherOther Has another Veterinarian ever treated your pet for behavioral concerns? * Yes No Who have they worked with? * Check any PRESCRIPTION medications they have tried: Trazodone Acepromazine Valium or Xanex Fluoxetine (prozac) Busipirone (Buspar) OtherOther Check OVER-THE-COUNTER medications, supplements, or devices you’ve tried to modify their behavior: Calming supplements (Theanine, tryptophan, etc.) Melatonin Benadryl Pheromone sprays/collars (Adaptil) CBD Thundershirt OtherOther Tell us anything you can about prior treatments and your pet’s response. Obtain records from the previous vet if at all possible and email them to us in advance. * Cats: Additional Behavioral History How many total cats are in the household? * How many literboxes do you have in the household? * Do you have litterboxes in more than one room? * Yes No Are any of the litterboxes hooded, or otherwise tightly enclosed? * Yes No How frequently do you scoop the literboxes? * Daily Every 2-3 days Once or twice a week More/Not frequently enough How frequently do you CLEAN the litterbox? * More than once a week Every 1-2 weeks Every month (or so) Less frequently… In general, we recommend: At least as many litterboxes as you have cats. Litterboxes in at least two locations in the household. No enclosed litterboxes – they concentrate odors that bother cats no matter how much you clean them. Large litterboxes that are easy to get in and out of. Avoiding noisy or high-traffic locations What is your perception of how the cats in the house get along? Are there dogs, or other free-roaming pets in the house? * Yes No What is your perception of how the cats get along with the other animals? A short video can be attached below. Bring longer videos to your appointment. Drop a file here or click to upload Choose File Maximum upload size: 10MB If you are human, leave this field blank. Submit
