Recommended Pet Behavior
History Analysis
To:
Dr. Rolan Tripp
Fax to:
1- 800-372-3706
From:
DVM (Name):
_________________________ DVM
Email: ____________________
DVM Fax:
_____________________
DVM Phone: ________________
Type:________
Re:
Contact my client
to offer the Analysis as the
hospital's Behavior Consultant.
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Date |
Please
print clearly |
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Hospital
Name |
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Hospital Phone: |
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Client
Name: |
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Client Email Address:
(if known) |
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Client Phone(s): |
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Pet Name: |
Species:
Breed: |
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Primary Behavioral Concern:
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Prefer an Email or Fax Report?
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If
you prefer, call in your request at
1-800-372-3706
Ext. 89.
You may also request a Behavior
Consultation with Dr. Tripp by
calling the Antech Doctor Consult
Line: 1-800-745-4725 Ext. 5
By submitting this form, I
the confirm the following
understanding: As the attending veterinarian (ADVM), I retain the
Veterinary-Client-Patient-Relationship (VCPR) for this pet and
client and agree to have my client contacted (on my behalf)
to offer and explain behavior services provided by a veterinary
behavior consultant (VBC)If my client
agrees then I will receive the
Analysis report with recommendations for
any indicated medical diagnostics and behavior medicines. My
client will pay the Animal Behavior Network (ABN) $120 for
the Analysis and a consultation to explain it and answer
questions (to save my time). I may consult (at no charge)
with the VBC and Veterinary Behavior
Technician (VBT) assigned to support my behavior case at any
time. If my client chooses additional behavior support
services from ABN, I will receive regular updates on the
behavioral progress of the pet and behavior modification
plan.
|
www.AnimalBehavior.Net
-
Veterinary
Behavior Services
Supporting the Attending DVM
