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Canine Initial Behavior Consultation History

Please complete the form below prior to your appointment. If you have any questions please email us at info@metro-vet.com.

"*" indicates required fields

General Information

Name*
MM slash DD slash YYYY

Basic Pet Information

Spay or Neutered?*
MM slash DD slash YYYY
Source

Did you meet your dog's parents?*

Household Information

Household Members (including you)*
Name
Age
Relationship to you
Occupation
Relationship with pet (e.g., follows, trains, no interaction, etc.)
 
Is anyone in the household pregnant or planning to adopt or foster a child in the near future? (This is asked for safety reasons. You are not obligated to answer.)
Have you had dogs as an adult before?
Household Pets (aside from dog presenting for evaluation)
Name
Species
Age, breed, sex, neuter status
Interactions with patient
 
Do you have a yard?*
Do you have a fence?*
Are you planning on moving within the next few months?*
Have there been any changes in your household since acquiring your dog (e.g. new job, move)?*

Aggression (if applicable)

Only fill out information about triggers that apply to your dog; otherwise leave the field blank.

For any trigger applicable to your dog, please describe specific incidents of aggression including:

  • your pet’s age when it was first observed and at the time of incident(s)
  • targets of the aggression
  • location
  • how you responded
  • frequency of incidents
  • body language (growling, barking, lunging, biting)
  • any other relevant information

    Bite History (if applicable)

    Has your dog made contact with an individual during the aggression?
    If your dog has a bite history, was any incident reported to Animal Control or other authorities?
    Is there any legal action pending because of this pet?

    Anxiety Screen

    Does your dog do any of the following more than you would expect?
    Does your dog display any reaction to noises such as thunderstorms, fireworks, or other loud noises?*
    Does your dog do any of the following?
    Does your dog show signs of stress while you are gone and if so, which ones?*

    Other Behavior Concerns

    Daily Activities

    Is your dog walked daily?*
    What other type of exercise does your dog receive?
    Is your dog playful?*
    Is your dog ever confined?*

    Training and Obedience

    Has your dog ever attended group training classes?*
    Have you ever hired a private trainer?*
    What cues does your dog perform regularly and reliably?

    Medical History

    MM slash DD slash YYYY
    Has your dog had baseline blood work (CBC, chemistry) performed within the past year?*

    Please list your pet’s current medications, supplements, or other treatments below

    Medications
    Name
    Dose (in mg)
    Frequency (e.g., once daily, as needed)
     
    Has your dog previously been prescribed medications, supplements, or pheromones for his/her behavior that are not listed above?*
    Any chronic medical conditions?*
    Any current or history of pain (limping, difficulty getting up or lying down, resistance using stairs, slowing down on walks)?*
    Have you noticed your pet exhibiting any of the following in the last 3 months?
    Does your pet have a history of seizures?*
    How would you describe your dog's appetite?*
    Does your dog have any confirmed or suspected food allergies or sensitivities?*
    Note: We will offer treats during the appointment based on this answer.

    Future Considerations