Please answer the following questions and submit this form. Once we receive the completed form, we will contact you about scheduling.

This form is designed to be completed online only. Please read all questions carefully and answer them to the best of your abilities. Include all relevant information. Not every question may apply to every animal.

This form is very detailed and may take up to an hour or more to fill out, depending on the complexity of the problems.

You are allowed to save the form in draft and return to it later. A link to the email indicated under 'Owner Information' will be sent.  Please note that the form will not allow you to submit unless all required fields are completed.

 (*) Indicates required field.

Please list all the people (including yourself) living in your household and the ages of the children (if under 18 years old).

Include each person’s attachment to the patient from 1-10 (with 1 being not attached and 10 very attached).

Describe several examples in detail:

The Cornell University Hospital for Animals is part of the College of Veterinary Medicine at Cornell. We are here to provide comprehensive and compassionate care to animals, provide an excellent learning experience for our veterinary students and to advance the understanding of disease and its treatment. 

As part of the training program for our veterinary students, closed-circuit television cameras have been installed in each of the examination rooms. The doctor may also opt to record video or pictures of your pet's behaviors for our records. These will be stored on your pet's file for future review. This also includes any video or picture material you submit or share with us as part of the consultation. 

Please indicate below if you allow us to use this material as part of educational teaching materials outside of Cornell or on social media (Facebook or others).  

Our goal is to communicate the cost of care and payment policies as clearly and transparently as possible before starting and throughout treatment. We welcome any questions you have at any time.

Initial Behavior Consultation:

The initial behavior consultation is approximately 90 minutes, conducted in person at our Small Animal Community Practice, 968 Campus Road, Ithaca, New York. More details about the appointment are included below. At that time, we will also schedule a 30-minute follow-up appointment (typically conducted via Zoom 4-8 weeks after the initial appointment).

• We will review your pet’s medical and behavioral history and conduct a risk assessment.
• We will discuss the diagnosis, prognosis, and initial treatment options.
• You will be provided with an immediate action plan including safety and management protocols, tools, and educational materials specific to your pet’s needs.
• Medications and supplements will be discussed and prescribed if appropriate for your pet.
• A physical exam will be performed as much as your pet will allow without causing unnecessary stress.

All consultations are private and confidential. A written report will be provided to you, your primary care veterinarian, and your trainer (if requested) within 72 hours of your appointment.

Please understand that we are only able to offer reasonable email support for 3-4 months following your pet’s consultation. Do not hesitate to contact us with concerns about your pet’s medications or the progression of severe behavioral problems. Otherwise, all other problems will require follow-up with the doctor.

Behavior Progress Exams:

• Scheduled by request. These appointments are 30-60 minutes, either in-person or remote. Please be aware that we must see your pet in person every 6-12 months in order to recommend treatment and prescribe medication.
• If new behavioral problems arise, or your pet is not progressing as hoped, follow-ups might be needed sooner to effectively analyze your animal's condition and to continue offering advice. Note that we will not be able to advise on major changes in the treatment plan without seeing your pet.
• You are responsible for scheduling all follow-up appointments. Please plan accordingly.

Pricing:

• Please call for pricing information.
• All initial consultations include a 30-minute remote follow-up appointment at no charge. All diagnostic tests, training tools, medications/supplements, and additional training and behavior modification sessions will be in addition to the consultation fee.

Payment Policy:

• Payment: Payment is due at the time of all services. We will contact you by phone after your remote appointment to arrange payment.
• Cancellation: We understand that schedules and circumstances change. We spend a significant amount of time in advance of your pet’s appointment reviewing the completed history form and medical records. We ask that you give us adequate notice (ideally 48 hours or more) if you decide to cancel your appointment.
• Prices are subject to change without notice.

By checking below, you understand that response to behavioral treatment or medical therapy cannot be guaranteed. Behavioral disorders can be very complicated and underlying causes are often multifactorial. The success of treatment depends on many factors, including your commitment to the behavioral modification plan as well as the correct administration of medications, if prescribed. Every effort will be made to anticipate and avoid an adverse reaction to treatment, but there may be unpredictable reactions or responses to treatment. If your pet is exhibiting aggressive behavior, liability for this behavior rests solely with you. Seeking and obtaining advice from a veterinarian does not transfer this liability. Furthermore, even if a pet’s aggression is diminished following treatment this does not ensure or imply that the aggressive behaviors will not occur again. By agreeing below you understand it is your responsibility to ensure the safety of other people, children, and animals that your pet may come in contact with.

Form Created 4/2024