Behavior Consultation Form

Principle Complaint
What do you consider to be your pet’s primary behavior problem(s)?
What do you think is the reason for your pet’s problem?
Describe the primary problem beginning with the most recent incident. Also describe any previous incidents, including the first incident you noted:
Describe the severity of the problem:
What age was your pet when the problem started?
Describe any changes in the home or in your routine when the problem first started:
How often does the problem occur?
Has there been a recent change in frequency or severity? If so, please describe:
Have you actually seen the problem?
What has been done so far to try and correct the problem?
Describe your pet’s response to the correction attempts (do some corrections work to improve the behavior, do some make your pet worse, etc):
Have you considered euthanasia for this problem?

YesNo
Comment on above?

Family Relationships
List each family member, including age and gender:
Briefly describe how your pet gets along with each family member:
List all other pets, including species, breed, age, and gender:
Describe how your pets get along with each other:
Briefly describe the daily family schedule, including how long your pet is alone:

Training

(for dogs only)
Describe any obedience training:
What will your pet do on command?
Which family member(s) have the best and the least control of your pet?
Please indicate whether you have tried the following:

Gentle leaderShock collarProng collarCitronella collarOtherNone of the above
If any of the above were used, how did your dog respond?
Have you ever used a crate or cage for confinement? If so, when?
If you still use a crate, please describe it, including location:
If you no longer use a crate, when and why did you stop?
Is or was the crate ever used for punishment?

YesNo
Which family member is most successful in disciplining your pet, and what type of discipline was used:

Nutrition, Exercise and Play
Type of food fed:
Is your pet fed on a schedule, or is food available at all times?
Briefly describe the amount and frequency of exercise or play your pet receives daily:
Which family member is most likely to exercise/play with pet:
Pet’s reaction to being left alone?
Reaction prior to owner departure?
Reaction at homecoming?
Describe where your pet stays during the daytime when you are home:
Describe where your pet stays when guests visit:
Where does your pet sleep at night?

Additional Problems

(describe briefly if not discussed previously)
Please check if your pet acts aggressively or threateningly in any of the following situations:

House soiling urine or stool, or urination when excitedPhobias (thunder, cars, loud noises, etc.)Shyness or timidity in new situations or around new peopleOther
Please describe if your pet has any of the additional problems listed above:

Morris Animal Hospital - Pet Behavior Questionnaire