Problem Behavior Consultation Initial Form

Name*

Address

Animal's Name

Species

Time in household

Gender (if known)

Provide a brief description of problem behavior (what does it look or sound like)

Approximately how long has behavior been considered a problem?

When is problem behavior MOST likely to happen?

When is problem behavior LEAST likely to happen?

Have you tried other behavior modification solutions? If yes, briefly describe

What would you consider a successful outcome for addressing this problem behavior?

Does your pet have any known medical conditions?

Has your pet had a complete veterinary exam to rule out medical causes for the problem behavior? If so, when?

Additional Comments