Client Information
Name

Veterinary Telemedicine Consultation Form

Patient Information
Species
Gender Status
Behavioral History
History
Aggression (check all that apply)
Targets of aggression (Check all that apply)
If Patient has bitten, number of bites
Duration of clinical signs
Anxiety/Fear
Anxiety and Fear
Situations
Duration of clinical signs

For cats only:

For behavioral periuria (inappropriate urination) consultations, pictures or videos of the
litterboxes and their locations must be submitted.

Elimination behavior (check all that apply)
Situations (check all that apply)

FOR ALL PETS:

Before your appointment, we need you to obtain 2-4 videos of your pet’s behavior issues to bring with you for submission of the consultation, as well as this completed form:

  • At least one video should be of the pet's behavior when they are home, not necessarily
  • performing the problem behavior. Include a video tour of the home environment.
  • For feline behavioral periuria (Inappropriate urination, cat urinating outside of the
  • litter box) cases, a video or picture of the litterboxes is necessary.
  • At least one video of the problem behavior
  • Do not endanger people or animals in making videos.

When treating veterinary behavior (psychiatric) cases, aggression is often a clinical sign. There is inherent liability in treating these cases. Your consultation is based on the information provided here and is not as complete as an appointment directly with a veterinary behaviorist. Take the time to read about the medications and treatments recommended so that you can make the best decisions for your pet with your veterinarian. Florida Veterinary Behavior Service and The Scottsdale Veterinary Clinic is not responsible for the outcomes of the cases for which they consult. Please read and sign to acknowledge that you understand and agree to the above statements.

Other body systems (to be answered for all pets)
Changes in overall health have a major impact on behavioral clinical signs. Make sure to check all that apply and use the "other" field if necessary.
Medical treatments
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