Behaviour Counselling Enquiry

Package 3 & 4 Pre-consultation

Which consultation package are you interested in?

For full package details and more information visit my behaviour consultation page.

Package 3: Clinic Visit Consultation - £375

Package 4: Consultation at Home - £450 + Travel Fees

If you are interested in a video consultation (Package 1 or 2), you can go straight to my behaviour questionnaire instead.

Owner Details

First Name

Last Name

Address Line 1

Address Line 2

Town / City

County

Postcode

Email Address

This is important, so I can get back to you. Please make sure this is correct. Thanks.

Patient Details

My pet is a...

Dog

Cat

Other

If other, please specify...

Name of pet

Age

Breed

Sex

Male

Female

Neutered

Yes

When were they neutered?

Referring Veterinary Practice

Name of Vet (if known)

Veterinary Practice Address

Address Line 1

Address Line 2

Town / City

Postcode

Is your pet insured?

Yes

Pet Insurance Company

The Problem

Please describe the problem that you are experiencing with your pet.

What problem behaviour is your pet exhibiting?

What methods do you use to try and stop the behaviour or deal with the problem?

Can you recall the first time the problem occurred?

Have there been any attempts (other than those already described) to treat the problem?

If so, what methods were used?

Additional comments

How much time do you feel able to commit to working with your pet to solve these problems?

What are you hoping to gain from the consultation?

How did you hear about me/my services?

Other (please specify)

Thank you for taking the time to complete the questionnaire. If you cannot answer all the questions please do not worry as we can discuss them in detail during your consultation.