AGREEMENT FOR EVALUATION OF

AGGRESSIVE ANIMAL BEHAVIOR

Please Read Carefully and Complete Prior to your Pet’s Appointment

Animal Name:                                                                                                  Species:                                                       

Age:                             Weight:                                  Gender:      ÿ M       ÿ F              Breed:                                                                     

I certify that I am the owner of the above-named animal.   I have asked the Lyndale Animal Hospital to evaluate this animal’s behaviors. 

I have been informed of the following:

• Aggressive behavior in animals is potentially dangerous.  Aggressive behavior can cause property damage and/or injuries, including fatal injuries, to other animals, people, and to me. I accept that I am responsible for any damages or injuries caused by my animal now or in the future.

• When my animal is seen at the Lyndale Animal Hospital, I accept that it must be appropriately restrained and/or confined (leash, kennel, basket muzzle, etc.) at all times, unless released by a member of the behavior staff.

• I understand that the creation of a treatment plan for aggressive behavior does not guarantee that the behavior can or will be eliminated.  I also understand that the only certain way to prevent future aggressive behavior may be to euthanize the animal; this option may be discussed during consultation depending on the specific nature of my pet’s behavior.

• Because aggressive behavior cannot be cured, I agree that it is my responsibility to:
• Be aware of and comply with all state and local ordinances concerning aggressive animals.
• Take appropriate precautions to prevent the animal from causing harm, including, but not limited to:
• Informing persons near the animal of its tendencies for aggression
• Keeping the animal confined, restrained or leashed at all times

My signature below signifies that I have read the above information, and understand that evaluation and treatment of my animal’s aggressive behaviors is not guaranteed to eliminate the behaviors.

Signature:                                                                                                                   Date:                                                                     

Printed Name:                                                                                                                

Clinician:                                                                                        Date/Time of Appointment:                                          

Behavior Evaluation