Skip to content
Keyboard Accessible Menu

(631) 923-2530

770 West Jericho Turnpike,
Huntington, NY 11743

Specialty Veterinary Care in Long Island NY 24hr Emergency Care for pets
Scroll to Gold Cost top
Gold Coast Center for Veterinary Care is on Facebook Gold Coast Center for Veterinary Care is on Instagram Gold Coast Center for Veterinary Care is on Google My Business
  • Home
  • About
    • Our Mission
    • Support Staff
    • Career Opportunities
  • Specialists
  • Veterinary Specialties
    • What is a Board-Certified Veterinary Specialist
    • Behavior
    • Cardiology
    • Emergency Care
    • HD CT Imaging
    • Internal Medicine
    • Oncology
    • Rehabilitation
    • Reproduction
    • Surgery
  • Pet Owners
    • Patient Forms
  • Referring Veterinarians
    • Referral Forms
  • Contact
  • Shop Now
Menu
  • Home
  • About
    • Our Mission
    • Support Staff
    • Career Opportunities
  • Specialists
  • Veterinary Specialties
    • What is a Board-Certified Veterinary Specialist
    • Behavior
    • Cardiology
    • Emergency Care
    • HD CT Imaging
    • Internal Medicine
    • Oncology
    • Rehabilitation
    • Reproduction
    • Surgery
  • Pet Owners
    • Patient Forms
  • Referring Veterinarians
    • Referral Forms
  • Contact
  • Shop Now

Home » Vet to Vet Canine Questionnaire

Vet to Vet Consultation – Canine Patient

Client Information

Client Name(Required)

Veterinarian Information

Patient Information

Patient Name(Required)

Dog Behavior History Questionnaire

Check all abnormal behaviors that apply to your patient. Skip any sections that do not apply.
Be specific – e.g., Reduce barking on walks at people
Aggression
Check all that apply
For family members, choose which of the following apply
For unfamiliar people, choose which of the following apply
Behaviors shown
Fear of Noises
Check all that apply.
Behaviors shown
Recovery time
Repetitive behaviors
Check all that apply
What surfaces are excessively licked?
Check all that apply
Departure Behaviors
When the owner prepares to leave the house, check the following that apply
Behavior When Alone
When the dog is alone, check the following that apply
Does the pet exhibit this / these behaviors only when left alone?
Does this occur for every departure?
Travel Fear / Anxiety
Check all behaviors shown on car rides
Vet Visit Fear / Anxiety
Check all behaviors shown on a vet visit or grooming
If your patient shows aggression in the vet clinic, check the following situations that triggered aggression
Physical Health Changes(Required)
Check all that apply
Current Medications / Supplements(Required)
If none, please put none
Medication
Strength
Dosing instructions
 
List all current and past diagnoses within the last 5 years. If none, write N/A.
Once our Client Service Representatives receive the questionnaire, they will contact the veterinary clinic/veterinarian within 2 business days to the email provided with a link to pay for the consult. After payment of $350 is made and the patient’s veterinary medical records and videos are received via email to behavior@goldcoastcvc.com, the sending veterinarian can expect to receive the behavior report within 3 business days of when the GCCVC Behavior Service is in the office (Tuesdays through Fridays). If you have any questions, please reach out to the Gold Coast Behavior Service at behavior@goldcoastcvc.com.
This field is for validation purposes and should be left unchanged.
Search

Veterinary Specialties

  • What is a Board-Certified Veterinary Specialist
  • Behavior (Practice Limited to Behavior)
  • Cardiology
  • Clinical Pathology
  • Emergency Care
  • Internal Medicine
  • Oncology
  • Rehabilitation
  • Reproduction
  • Surgery

If your pet is having an emergency, contact West Hills

24 hr - West Hills Animal Hospital in Huntington

Links

  • Web Accessibility Policy
  • Terms of Use
  • Privacy Policy

Hospital Affiliations

  • AVMA
  • New York State Veverinary Medical Society
  • USDA
  • American College of Veterinary Surgeons
Gold Coast Center for Veterinary Care in Long Island City

Gold Coast Center for Veterinary Care

770 West Jericho Turnpike
Huntington, NY 11743

(631) 923-2530

Our team of Board-Certified Veterinary Specialists use their expertise every day so that your pet has a chance of a healthy recovery and long life with you and your family

https://goldcoastcvc.com/

Gold Coast Center for Veterinary Care

Stay Connected

fb.png
instagram.png