Behavior History Form

    Behavior History Form - Dog / Cat

     










     












     





     





     

    EXERCISE:










     

    MEDICAL CONSIDERATIONS:











     

    ANY ACCIDENTS IN HOME:


















    DOES YOUR DOG?:













    YesNo

    We require a $60 deposit to be made when you schedule your appointment. The deposit is non-refundable

    If Dr Foote has not physically examined my pet, the video chat is a Teletriage/teleadvice consult. Dr Foote will not be prescribing medication, making a diagnosis or prognosis about my pet. Dr Foote will collaborate with my primary care veterinarian who will be the one to prescribe medication, make a diagnosis or prognosis about my pet.

    Telecommunication with the veterinary staff is limited to the hours of availability determined by the veterinary staff.


    * Payment is due upon receipt of invoiced services. A $5 MINIMUM OR A 2% MONTHLY CHARGE IS ADDED TO ALL BALANCES. * Any unpaid balance over 60 days will be send to collections, with all fees for collection services added to the balance for services.