Permission for Behavioral Evaluation

Litchfield Veterinary Hospital

289 Torrington Road
Litchfield, CT 06759

(860)567-1622

litchfieldvet.com

Permission to Treat  - Behavioral

This form is used for permission to evaluate and treat cats and dogs for behavioral complaints, concerns, problems and pathologies. To download/print this form and fill it out, click here. This form needs to be provided along with the Canine or Feline Consult/History form.

For the Canine Behavioral Consult/History Form, click here. For the Feline Behavioral Consult/History Form, click here.

Permission to Evaluate and Treat

Please read the following and "sign"/date below
A history form (provided) will need to be completed before we can evaluate your cat/dog. The information you provide on this form and during the appointment is considered confidential. Please keep a copy of the history form for your own records.

If you have any behavioral evaluations or physical/laboratory exams done elsewhere, it would be helpful if we had a copy before your appointment.

You may also be asked to provide a video and/or photos of your dog or cat. We request these because it is the best way to see the behaviors that concern you within the context of everyday life. The video should: -show the behaviors about which you are concerned, excepting any injurious behaviors -give a brief tour of the dog's or cat's environment (house/apartment and yard) -Show any other relevant facets of the patient's life (e.g. where your dog or cat sleeps, sits, eats, drinks, walks, plays, interaction with other animals, etc.)

If aggression with injury is one of the complaints, please do not provide a video of the dog or cat biting someone, and do not put the dog or cat in a situation where any aggression may be provoked. If aggression is a concern, other behaviors will be indicative of it.

Videos and/or photos may also be taken during the appointment. Any videos/photos used to evaluate the patient become part of the record and may be used anonymously in all modes of teaching (including teaching staff or other clients) and/or research.

The appointment will start with your dog on a lead and/or your cat on a lead and hardness or in a carrier. Further management of all interactions with humans and/or other animals is at the discretion of the clinician. This policy helps to keep everyone as safe as possible and distress the patient as little as possible.

Behavior appointments can be lengthy and the amount of time we schedule for the initial appointment and the plan for the appointment(s) will be explained when you schedule the appointment. By completing these forms and signing below, you give permission for us to evaluate, assess, formulate a treatment plan, and treat your dog or cat. You will receive a written copy of the discharge instructions and treatment plan, and we encourage you to comply with our recommendations and to ask questions at any time.

The evaluation, assessment, and treatment plan do not represent a guarantee of successful treatment. Few behavioral problems are truly cured, and responsible management is a factor for every patient.

If your dog or cat is aggressive, you should know the following: -Any animal who is aggressive for any reason can do serious damage and harm. -Special precautions must be taken to ensure that everyone is safe. These precautions may include some form of confinement (e.g. gates, crates) or the use of leads, harnesses, head collars and/or muzzles. -Proof of current rabies vaccination, where required by law, should accompany your completed history forms. -Seeking treatment for a behavioral problem and/or treating a behavioral problem is not a substitute for adherence to local laws. -Owning a cat and/or dog carries with it responsibilities, including responsibility/potential liability for any damage the dog and/or cat does to people or property. This responsibility is not changed/transferred by seeking behavioral help. -Problems involving pathological behaviors, including aggression, are never cured but they can be well treated and managed, to the point where the dog or cat lives a happy, safe life. Failure to manage and treat these problems may lead to euthanasia. Even as a last resort, the death of a pet is an outcome that everyone would seek to avoid, if at all possible. The point of this appointment is to provide humane care that allows your dog or cat to live a long and happy life.

If you have any questions about this form or the history form, please ask. Clear communication helps produce the best outcomes.
Name of person responsible for the cat and/or dog (required)
First Name (required)
Last Name (required)
Date (required) :

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