History Form History FormClient informationFirst NameLast NameEmailPhone/MobileAddressAddress Line 1Address Line 2CityZip CodePet informationPet dog cat otherPet nameBreedAgeSex male femaleNeutered?; At what age?Other animals in home? Please include species, breed, age and names.How long has this pet been with you?Where did you get him/her - breeder, shelter, rescue, pet store, private?How old was she/he when joining your family?HistoryWhat is the main problem you are experiencing with your pet?When did it first occur?What do you know about the animal’s history prior to becoming his/her guardian? How often has it happened?Any pre-existing behavioral issues you are aware of? Please describe:Any traumatic events that you know of? Please describe:Have there been any life changes in your household recently - moving homes, family make-up, new pets, medical issues, etc.?How have you been managing the problem behavior?Have you received professional help prior to contacting me? Please describe:RoutinesPlease describe a typical day for your pet:What sort of enrichment activities do you provide? Please list and include frequency. Have you done or do you do any training with your pet? What kind of training?Do you play with your pet? What does that look like?How much time does your pet spend alone or just with other pets? Please describe:What do you feed your pet? Please be specific.Does your pet also get treats? If so, what kind and how often?Does your pet have any diet restrictions? If so, what and why?Is your pet on any medications? What is it and for what reason.Submit History Form
