Redmond Veterinary Clinic
Providing Uncompromised Care for those Providing Unconditional Love
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Preliminary Behavior Questionnaire
Search:
Contact Name and Email:
First Name:Last Name:
Email:
Home Phone:
Cell Phone:
Animal Name:
Pet Age:
 
Species:
Breed:
Sex:
Spayed/Neutered?:

Medical History
When was the last physical examination performed on your pet?
Does your pet have any preexisting or current medical problems?
If yes, please describe:

Background Information:
How old was your pet when you first acquired him/her?
Where did you acquire this pet from?
What kind of living situation do you have?
Where is your pet when left home alone?

Behavioral Problem:
Please use the boxes below to list the behavioral problem(s) that you wish to address, and how much of a problem do you consider the behavior to be?
Behavioral Problem 1:

Behavioral Problem 2:

Behavioral Problem 3:

Describe a typical episode of the behavioral problem(s):
How often does the behavioral problem occur?
What have you tried to do to change the problem behavior? Please list all things you have tried whether they have been useful or not.
For Dogs Only
What commands does your dog know and how well?
Sit
Lie Down
Drop it
Stay
Fetch
Come
Heel
For Cats Only:
How many litter boxes do you have?
Does your cat use a scratching post?
Does your cat have any outdoor access?
Summary
Have you considered finding another home for your pet?
Have you considered euthanasia (putting your pet to sleep)?
Is there any other information you would like to add?

 

Redmond Veterinary Clinic 1785 N. Hwy 97 Redmond, OR 97756 (541) 548-1048 Fax (541)548-2323 e-mail us | site map | Employees Only Content Management System provided by
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