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Client/caregiver

DIET

MEDICAL

ADDITIONAL HOUSEHOLD INFORMATION

TRAINING

How does your pet respond to the following types of handling?

How does your pet react to the following?(calm,excited,fearful,friendly,aggressive)

Behavior Problems Information

The Problem Occurs:

Additional Questions for House soiling or Litterbox Problems

Is there a preference for urinating inappropriatley on:

Medical History

Litterbox Information(cats).

Where are you on a scale from 1 to 5 as follows: