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About
New Patients
Services
Resources

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Having An Emergency?
Pay Bill Now

Facebook-square Store-alt Yelp

Book Appointment
Online Pharmacy

About
New Patients
Services
Resources

About
New Patients
Services
Resources

Mon–Fri: 7:30AM–7PM
Sat: 8AM – 5PM
Sun: Closed

425-432-9975

23714 222nd Place SE
Ste L
Maple Valley, WA 98038

Mon–Fri: 7:30AM–7PM
Sat: 8AM – 5PM
Sun: Closed

425-432-9975

23714 222nd Place SE
Ste L
Maple Valley, WA 98038

Behavior Consultation Form

Behavior Consultation Form

We know your pet’s health is important and we thank you for choosing us to care for your pets. To help us provide the best care possible, please take a few moments to fill out this form. All of your information is confidential. Thank you!

"*" indicates required fields

Date*

MM slash DD slash YYYY

Owner's Name*

First Last

Pet's Name*

Breed*

Sex*

Male

Female

Is your pet spayed/neutered?*

Yes

No

I Don't Know

Age/Date of Birth*

Do you have a second pet with behavioral issues?*

Yes

No

Second Pet's Name*

Second Pet's Breed*

Second Pet's Sex*

Male

Female

Is your second pet spayed/neutered?*

Yes

No

I Don't Know

Age/Date of Birth of Second Pet*

Please list any additional animals in the household (include species, age, and sex):

What is your primary concern regarding your pet's behavior?*

How would you rate the severity of this problem?*

Mild

Moderate

Severe

When did this problem begin? (Please include how old this pet was when this problem began)*

Have there been any recent changes in the frequency or severity of this problem? If yes, which other pet(s) is/are involved?*

Does this behavior concern involve any other pets in the household?*

For the following questions, please answer in regards to the pet with the primary behavior concern.

Where did you obtain this pet, and at what age?*

Where did you obtain this pet, and at what age?*

Were there any noticeable changes to this pet’s behavior after spaying/neutering? If yes, please explain what you noticed.

Briefly describe this pet’s personality:*

How often is this pet fed?*

Do you give your pet treats? If yes, how often? What kind of treats?*

Please list all family members that live in the home with this pet. (Please include age and gender).*

Please list all family members that live in the home with this pet. (Please include age and gender).*

What is your pet's favorite reward?*

Is your pet accustomed to being left alone?*

Yes

No

When you go out, is this pet confined or crated? If yes, please describe.*

How long is your dog left alone on an average day?*

Less than 1 hour

1-2 hours

3-4 hours

5-6 hours

6-8 hours

More than 8 hours

Have you ever left your dog at a boarding facility, veterinary office, or pet sitter? If yes, please briefly describe.*

Please briefly describe a normal daily schedule for your family.*

Is your dog completely potty-trained?*

Yes

No

My pet used to be potty-trained

My pet is still being potty-training

Has this pet had any training? If so, what kind? (Group class, private instructor, board & train, owner training, etc.)*

If your pet has seen a behavior professional previously?*

Yes

No

What training methods have you employed for this pet?*

Are there any training methods in particular that have seemed to make this behavior problem better or worse? If yes, please describe.

On average, how long does it take for your pet to “settle down” after exhibiting the behavior problem? (How long does it take for your pet to return to their normal behavior?)*

Is there any ongoing training? If yes, please briefly describe.

Are there particular places your pet’s behavior changes?*

Veterinary office

On leash

In crowded places

Around other dogs

Around other species

In a crate

In a moving car

Around loud noises

Other

Please Describe:*

Would you describe your dog as reactive to any particular stimulus? (E.g. my dog barks excessively when the doorbell rings; my dog loves people, but is fearful of men with hats on; my dog loves to play with other dogs, but just “goes crazy on leash”)*

Has your pet ever bit, or attempted to bite, a person or other animal?*

Yes

No

Please Describe:*

Is there any other information regarding your pet’s behavior you’d like us to know?*

Email*

Enter Email Confirm Email

Email

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Mon–Fri: 7:30AM–7PM
Sat: 8AM – 5PM
Sun: Closed

Address:

23714 222nd Place SE
Ste L
Maple Valley, WA 98038

Email:

reception@wildernessvet.com

Phone:

425-432-9975

Fax:

425-432-6675

Hours:

Mon–Fri: 7:30AM–7PM
Sat: 8AM – 5PM
Sun: Closed

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