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Happy Holidays! 🎄 We will be closed on December 24th - 25th and January 1st. We will close at 4 pm on 12/31 New Year's Eve. 🎊
If your pet is experiencing an emergency, please contact the
Charleston Veterinary Referral Center
at 843-614-8387
Hours & Contact
Monday - Friday: 8:00am - 6:00pm
(843) 483-5838
[email protected]
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Behavioral Progress Evaluation Questionnaire
Client Name
Email Address
Pet Name
Please list the current problem behaviors you are working on
Please list any problem behaviors that have not been addressed
Please list all of the medications and supplements you are currently giving your pet
Include: drug name, concentration, amount given, interval
Please note the response your pet has experienced as a result of the medications (Changes in your pet's behavior, problems, improvements, appearance of undesirable behaviors). Please check all that apply.
Profound side effects
Minor side effects
No side effects
Wholly improved (100%)
Decreased in frequency or extent 75-90%
Decreased in frequency or extent 50-74%
Decrease in frequency or extent 25-49%
Decreased in frequency or extent less than 25%
No change at all
Worse
Other notations
Enter other…
Have there been any incidents of the problem behaviors for which you have sought help since last seen? If so, what happened, what were the circumstances and how did the pet react?
How are you handling the problem behaviors that specifically have given you trouble?
How are those efforts working, and what does your pet do when you use them?
Have there been any new behaviors that have developed since the last appointment? If so, what specific behaviors have developed in what circumstances do they occur?
Have there been any changes in the household (pet and human) since the last consultation?
Is your pet using a head collar or no-pull harness? If so, has this helped with any of the problem behaviors? If so, which ones?
Do you have any questions about the appropriate use of head collars or harnesses?
Are you successfully and consistently exercising the behaviors discussed in the protocol for deference?
Yes
No
Are there any parts of the programs or protocols with which the pet or you are having more difficulty than others?
Is there any family member who is having more trouble with the program than other?
To whom does your pet currently best listen? Is this a change?  Why do you perceive that this difference exists?
How do you feel your pet is progressing with regard to the intensity or severity of the problem behaviors?
worse
No change
25% improved (@3/4 intense as in the past)
50% improved
75% improved (@1/4 intense as in past)
90% improved (seldom occurs)
How do you feel your pet is progressing with regard to the frequency of the problem behavior? Do you think your pet is:
worse
No change
25% improved (@3/4 less frequent)
50% improved
75% improved (@1/4 less frequent)
90% improved (seldom occurs)
Has the program and protocols helped in dealing with your pet (more relaxed, understanding, confident)?
What have the reactions of others (friends, neighbors, other pet owners, etc) been to the pet-owner participation in behavioral therapy?
Have you found that, in your discussions with others about your pet, other people have made helpful suggestions?   If so, what were these suggestions?
Is there any other information that you believe is relevant to your pet's behavior problems (changes in diet, illness, other)?
