Behavior Evaluation Form

Patient Information

Consent to Evaluate and Treat

Behavior appointments can be lengthy, and the forms we request ahead of time will help to make this appointment flow smoothly. By completing these forms and signing, you are giving us permission to evaluate, assess, formulate a plan, and treat your pet. You will receive lots of information during this appointment, and we encourage you to ask questions at any time - even after the appointment.

The evaluation, assessment, and treatment plan do not guarantee successful treatment. Your active participation, continued training, and follow through are critical to success. We may ask you to provide videos or photos of your pet and/or home. These can provide us with an insight into the behavior at hand and provide information about the patient's life. If aggression is one of the reasons you are seeking care, please do not provoke your pet or put them in the situation in which they feel the need to use aggression. Videos and/or photos may also be taken during the appointment to evaluate the patient or become part of the record. Any videos or photos used to evaluate the patient may be used anonymously in all modes of teaching and/or research.

Problems involving pathological behaviors are not cured but can be managed and treated with success. The goal is always to provide a happy, safe, healthy, and fulfilling life for the patient. Failure to manage or treat these problems may lead to euthanasia. Euthanasia is often a last resort, and something that everyone seeks to avoid, if possible. There are, however, cases where euthanasia must be discussed for humane or safety reasons.

For Patients with Aggression:

• any animal can cause harm or serious damage
• precautions must be taken to ensure the safety of everyone. These may include some form of confinement or barriers, leashes, head collars, muzzles, or distance training.
• proof of rabies vaccination should be submitted with this form
• seeking treatment for a behavior concern does not shift the responsibility or liability for any damage that your pet may do to people or property, you as the owner, still maintain complete responsibility and liability for your pet

To avoid any confusion, Dr. Tasman Flora is not a board-certified specialist in behavior. She is a general practice veterinarian with a passion for behavior that has pursued continuing education in behavior and training. If you would like referral to a board-certified specialist in behavior, we will happily, assist in this process.

If you have any questions about this form, or anything else related to this process, please ask. By signing this form, you indicate that you understand and consent to the contents of this form.

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