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Behavior Consultation Questionnaire
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* Indicates required question
Client Full Name
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Pet's Name
*
Your answer
Pet's Age
*
Your answer
Pet's Breed
*
Your answer
Your current Veterinarian
*
Your answer
Current Veterinarian's Number & Address
*
Your answer
Is your pet spayed/neutered?
*
Yes
No
Where did you obtain this pet? Friend, breeder, pet shop, humane society, other?
*
Friend
Breeder
Pet Shop
Humane Society
Rescue Organization
Other:
For what purpose was the pet obtained? Companionship, protection, breeding, show, other
*
Companionship
Protection
Breeding
Show
Other:
Where does your pet primarily stay?
*
Indoors
Outdoors
Is the pet left alone during the day?
*
Yes
No
If your pet is left alone during the day, how long?
Your answer
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