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.