JM - Behavior Consultation Form

  • Morris Animal Hospital - Pet Behavior Questionnaire

  • Principle Complaint

  • Have you considered euthanasia for this problem?

  • Family Relationships

  • Training

    (for dogs only)

  • Please indicate whether you have tried the following:
  • Is or was the crate ever used for punishment?

  • Nutrition, Exercise and Play

  • Handling

    Please describe how your pet responds to the following scenarios:

  • Aggression Data:

  • Please check if your pet acts aggressively or threateningly in any of the following situations:
  • Does your pet act fearful at the time of the aggression, or in response to your correction attempts? (ie cowering, ears back, tail tucked)
  • Was there any illness or health problem when the aggression started?

  • Additional Problems

    (describe briefly if not discussed previously)

  • Please check if your pet acts aggressively or threateningly in any of the following situations:

  • Feline House Soiling Information

    ** Please complete the following secton only if your pet is a cat and is urinating or defecating outside the litter box.

  • The inappropriate elimination incidents are:

  • Does the elimination problem occur when the pet is left alone?
  • In the presence of family members?
  • During the night while the family sleeps?
  • Is there a preference for urinating on:
  • Is there a preference for secluded areas? (closets, under furniture, rarely used rooms)?
  • Does your cat have a surface preference when eliminating outside the litter box (rugs, clothing, paper, hard surfaces, etc)?
  • Has your cat ever eliminated consistently in the litter box?
  • Do strays or pets from other homes visit or come outside windows, doors or in the yard?
  • Has your cat ever had a urinary bladder infection?
  • Does any straining, pain, or blood accompany your pet’s urination or defecation?
  • Has there been an increase in the amount of water consumed?

  • INCLUDE A DIAGRAM
    Please draw a basic diagram of your house and indicate areas of inappropriate elimination and litter box location. Bring the diagram with you to your appointment.

  • SUBMITTING YOUR FORM:
    Please complete the following section to submit your form to us via email. If you have not already done so, please be sure to call our office (574) 271-1909 to schedule your appointment. Thank you!

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