Consulting Application Form
Behavior & Personality Evaluation For Dogs
Please complete this questionnaire as thoroughly as possible. All of your answers will be confidential.
The details you provide will give an initial understanding of your dog's problems. We want our first consultation to be as helpful as possible so please collaborate with others in your home.
More information as well as more perspectives will make a bigger difference. If you do not know the answer to any of the questions, please write in UNKNOWN.
Finally, your dog's regular veterinarian needs to stay informed. This will be especially important if medications are recommended or if there is a physical component to the behavior concern. You may need to report to your veterinarian as we progress. We will consult with you on the behavior issues until we get the best possible result. If there are more serious neurological issues suspected, a referral to a Board Certified Veterinary Behaviorist may be suggested.
* Required
Email address
*
Your email
Pet Owners Name
*
Your answer
Best Contact Phone
*
Your answer
Alternative Contact Phone
Your answer
Physical Address (please include city)
*
Your answer
Mailing Address
*
Your answer
Name and address of regular veterinarian
*
Your answer
What is your living arrangement?
*
Apartment
Townhome/Condo
House with Small Yard
House with Large yard
Farm
Please list the people (including yourself) who are living in the household. Name - Sex - Age - Relationship to you - Occupation - # of Hours at home each day
*
Your answer
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