Medication Consult Questionnaire

Please complete the questionnaire below. If you need immediate assistance, please call us directly during business hours at 509-462-7387. If you are a new client, please use our new client form to be registered in our system. If you have multiple pets, please fill out the following form for each individual pet.

Name *

First

Last

Phone *

Email *

Pet's Name *

Please describe the main behavior problem or complaint: *

Does your pet show any signs of aggression with people or other dogs? *

Does your dog have any history of biting, nipping, snapping, or growling at people? *

Where did you acquire your pet? At what age did you acquire your pet? *

Has your dog had any formal training? Please describe. *

For new clients: is your pet on any medications or supplements? Does your pet have any serious medical issues or long-term health conditions? *

I understand that this appointment is for an initial behavioral consult to determine if medications are needed and to make a personalized plan for next steps. No training will be done at this appointment. *

I have read and understand

I accept and acknowledge personal responsibility and liability for any injury or damage caused as a result of the wrongful or aggressive behavior of my dog, whether the loss occurs as a result of biting, jumping, scratching, digging, charging or any other behavior. I hearby release Latah Creek Animal Hospital from any and all liability for any losses, damages, or injuries of whatever kind or nature, including attorney's fees, resulting from any personal injury or damages caused by the patient. *

I have read and understand

Medication Consult Questionnaire

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