Exotic Cat Questionnaire Form

Florida Veterinary Behavior Service
Lisa Radosta DVM, DACVB

3421 Forest Hill Blvd, West Palm Beach, FL 33406

Phone:561-795-9398 Fax:561-795-8537

Email: info@flvetbehavior.com Web: www.flvetbehavior.com
Hello!
Thank you for making a behavioral medicine appointment for your pet. We have been providing specialty behaviorial medicine treatment to our patients in south Florida since 2007. My team and I are committed to helping your pet overcome his or her behavior disorders.

In this packet, you will find a registration form, tips for your pet's appointment and a patient questionnaire. Please fill out these forms and fax (561-795-8537) or email (info@flvetbehavior.com) them back to our office at least 3 days prior to your appointment. We will get in touch with your primary care veterinarian(s) directly to request your pet's medical records.

Please let us know what we can do to help you in the time leading up to your pet's appointment. You can find maps with our location information and direct numbers to those hospitals at our website:www.flvetbehavior.com.

We are looking forward to meeting you and your pet!

Sincerely,

Dr. Lisa Radosta, Dr. Fagen and the Florida Veterinary Behavior Service team

Florida Veterinary Behavior Service Registration Form and Waiver
Primary owner (your pet's medical record will be under this person)
Full Name

First Name Last Name
Primary Phone Number

Area Code Phone Number
Secondary Phone Number

Area Code Phone Number
E-mail
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Secondary owner
Full Name

First Name Last Name
Primary Phone Number

Area Code Phone Number
Secondary Phone Number

Area Code Phone Number
E-mail
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Who is your pet's primary care veterinarian? Please list the veterinarian, clinic name and phone.
Do you have a secondary veterinarian that treats your pet? If so, please list the veterinarian, clinic name and phone.
Who referred you to the Florida Veterinary Behavior Service?
I am the owner(s) of the animal(s) seeking behaivoral medicine treatment from the Florida Veterinary Behavior Service. Behavioral treatment, training and advice when properly maintained after completion can be very helpful in resolving problem behaviors in aniamals. Because each pet is an individaul, no guarantee or assurance can be made as to the results that may be obtained. Animal behavior including aggresion is unpredictable and will remain unpredictable after its treatment. Florida Veterinary Behavior Service cannot promise that the animal's Behavior Service treatment, training or advice will completely eliminate the animal's potential danger to persons or completely control the animal's aggressiveness. Animals should be closely supervised particularly around children and infants and should be controlled at all times including conformance with local ordinances and "leash laws."

I am bringing my pet to this appointment with a full knowledge of these risks and understand and accept the liability that is inherent in owning a pet who has shown aggressive behavior.

I understand that all fees are to be paid at the time of service and accept full responsibility for the charges incurred in the treatment of my pet
Primary Owner's Signature (use your cursor to sign)
Secondary Owner's Signature (use your cursor to sign)

Helpful Hints...
Videos can be very helpful when assessing a pet's behavior patterns. Please send videos of your pet's environment and the behavior problem itself to us at the email above. If the video is too large to send it by email, please upload it to Youtube or Dropbox and send us a link. Do not under any circumstances provoke aggressive behavior in order to get us a video.

Bring all pets that are involved in the problem to the appointment if you can do so safely. If your other pets are not involved directly in the problem for which you are seeking help, it is better for you to leave them at home so that we can concentrate solely on the pet who needs help.

For intercat aggression (to the other cats in the household), it is essential that all cats who are involved in the fighting come to the appointment. If this cannot be done safely, please contact our office for further direction on which pets to bring with you to the appointment.

Bring your pet's favorite toys and treats with you to the appointment in case we treat your pets on that day or we can use those items during your pet's appointment.

Medical History
Please describe any significant medical illnesses, treatments and the outcome.
Behavior Problem Information

Please fill out the section below regarding your three top concerns about your pet's behavior.
What are your goals for this appointment?

0/100
Problem 1

0/50
Age at which problem 1 started
Frequency of problem 1
Please give a description of the significant representative event for this problem.

0/100
Problem 2

0/50
Age at which problem 2 started
Frequency of problem 2
Please give a description of the significant representative event for this problem.

0/100
Problem 3

0/50
Age at which problem 3 started
Frequency of problem 3
Please give a description of the significant representative event for this problem.

0/100

Did someone recommend euthanasia before your visit to us?

Yes No
Have you considered euthanasia before your visit to us?

Yes No
Have you considered rehoming your pet before your visit to us?

Yes No
Anything else that you would like to share with us about your pet?

0/50
Should be Empty:

Florida Veterinary Behavior Service

Florida Veterinary Behavior Service Registration Form and Waiver

Helpful Hints...

Exotic Cat Behavioral Questionnaire