Patrick Melese DVM, DACVB & Crystal Steib DVM
Behavior Service Policies/Fee Schedule:

Welcome to Veterinary Behavior Consultants. The following list details some of our office financial and medical polices. Please take a moment to familiarize yourself with them so that we can serve you better. If you have any questions or constraints regarding these or any of our policies or practices, please feel free to discuss them with us PRIOR TO YOUR APPOINTMENT!

•	Fees have been explained to me clearly and I realize that no exact representations are made or implied as to an exact fee total since hourly charges apply, each case is different and behavior products or training aids may be recommended. Although Covid 19 pandemic conditions still effect our practice, we are now offering new patient clinic appointments but are still doing some by telemedicine with brief “curbside exam” component as required by law (i.e., initial appointment and every 12 months). Our new patient appointment fees are as follows: $990 for up to a 3-hr session. 
•	Since a number of complicated cases need a bit more time, especially if doing a separate “curbside exam,” additional time over 3 hrs (when available) will be prorated at $330/hr rate and additional $200 if additional pet patient(s).
•	Consultations that must be scheduled outside regular clinic hours with Dr. Melese (M-Wed 9:30-5:00), when available, are charged additional hourly rates.  For Guidelines only-not a quote:  Initial patient appointments usually range between 2.5-3.5 hours. A routine telemedicine phone recheck appointment is currently $260 (30-45 min.) but, for stabilized, long-term cases, can sometimes be shorter (e.g., $220 if <20min) and 1st rechecks are usually booked 1-2 months after initial appointment. Recheck appointments are typically critical to the successful resolution of most cases, but how many and how often is very dependent on the problem, the patient(s), and the individual clients. AS OF 2010 ALL FEES ARE BASED ON E-MAIL CORRESPONDENCE. Please see website for details but we are also requiring a non-refundable $300 scheduling fee to reserve the clinicians’ time for a new-patient spot for you, which will be credited towards your total/final appointment fee.
•	Fees may be adjusted without notice based on practice costs and inflation but are usually re-evaluated every 6-12 months so the recheck fees may be different than listed above for the following years.

Notes:
•	Appropriate family members (especially spouses) and pets should be present as possible/ practical for 1st appointment.**
•	If pet has ANY relevant medical history &/or lab work done within past 6-12 mo. or is on medications (have meds with you), have your vet e-mail/FAX appropriate medical records at least 24 hrs. before appointment so we have them @ appnt.
•	For new telemedicine appointments we use ZOOM. Plan to be ready at least 5 minutes early for any technical issues. In most cases, you may lose some of your valuable appointment time if you are not ready on time so test/plan ahead to be “ready to roll” at appointment time.  For clinic visits call clinic directly to reach us on appointment day: (619-275-0888).
•	Please have all halters, collars (including any electronic training collars) and other training aids you have (especially head halters e.g., Gentle Leader®) & medication your pet is on or has been on recently with you even if you are not now using it.
•	We HIGHLY recommend that you AUDIORECORD (e.g., smartphone app, Zoom, other) the session so prepare for this! 

If you have any questions about fees, please inquire prior to the consultation. Any exceptions to fees above MUST BE IN WRITING!

•	Payment is due at time of appointment; no billing. You may pay with cash, Zelle or Venmo but, if you choose to pay by credit or debit card (Visa, M/C or Discover), there will be an additional 6% convenience charge on amount charged to your card. Payments not honored by bank will also incur an additional $35 fee and you also agree to pay for any costs associated with collecting the funds to pay for the services and products you have received including an additional $25 billing fee if your account is not paid in full at appointment & must be invoiced.
•	Although your scheduling fee is non-refundable, since we schedule out a large portion of the doctor’s schedule for your behavior appointment, we request immediate notification of any desire to reschedule or cancel a behavior consultation so that another client can make arrangements to use the appointment time.  Please give us AT LEAST 2-3 business days advanced notice of cancellation. If you do not show up for your appointment or cancel with less than 2 business days (M-F) notice, you may be charged the full consult fee. 

I, 				  have read the polices put forth above and understand them fully. I agree to adhere to these policies as a client of Dr. Melese’s practice VBC and my signature below authorizes any credit card charges I incur with VBC (e.g., phone appointments) or as per policy above (e.g., missed appointments).

Hand Signed: 						 Date: 				

** If seen at Morena Pet Hospital clinic, the exam room is only just so big so consider this regarding who all attends.

Dr. Patrick Melese DVM, DACVB & Dr. Crystal Steib DVM

LIABILITY WAIVER

Thank you for caring enough to obtain help with your pet’s behavior!

	As the representing owner, agent or handler for the individuals who will be working with the pet(s) indicated below, I understand that many behavior therapies recommended by the doctor may involve some level of risk to the pet(s) and/or the handlers, or other people or property in spite of our best efforts to minimize them.  In some cases, medications may be recommended as part of the treatment; most are human medications being used "off-label" for pets (i.e., not FDA approved for that use in that species) and it is rare for a medication alone to solve most pet behavior problems.  I understand these issues and assume these risks freely and do not hold Dr. Patrick Melese DVM, DACVB, Dr. Crystal Steib, Veterinary Behavior Consultants, Morena Pet Hospital or associated clinicians, agents, employees, or owners/agents for clinic facility used to see cases liable for any injury which may occur to handlers, pet, other people, other animals or property while using their training and medication treatment recommendations. I will use my own judgment and common sense when following the recommendations to not place people, pets and property at undue risk and understand that, ultimately like any pet owner, I am exclusively responsible for my pet’s actions.
  
	FURTHERMORE, I REALIZE THAT DR. MELESE, DR. STEIB, VETERINARY BEHAVIOR CONSULTANTS AND Its STAFF & AGENTS CANNOT GUARANTEE THAT A PET WILL NOT BE AGGRESSIVE OR CAUSE INJURY TO PEOPLE OR PROPERTY IN THE FUTURE AND THAT THE PET'S OWNER(S) AND HANDLER(S) CONTINUE TO ASSUME ALL LIABILITY FOR ANY FUTURE AGGRESSION.
         		
Owner’s Name(s): 										
Address: 					City: 			State: 		  Zip:		 Telephone: (H)	            		 (W) 				  E-mails:_________________________

1st Pet's Name: 	                         Species (dog/cat): 		  Breed: 			
Pet's Birth Date: 	Age: 	    Sex: 	                Pet's color/description: 	             	
Comments: 			                                                                           		

2nd Pet's Name: 	                         Species (dog/cat): 		  Breed: 			
Pet's Birth Date: 	Age: 	    Sex: 	                Pet's color/description: 	             	
Comments: 			                                                                           		

I certify (hand sign please) that I have read and agree with above statements:

Owner of Pet(s): 							DATE: 			

Spouse, Other pet owner/handler(s): 					DATE: 			

 RECHECK APPOINTMENTS ARE STRONGLY RECOMMENDED AND USUALLY CRITICAL TO LONG TERM SUCCESS!

Please e-mail (info@sdvetbehavior.com) with a progress report
 2-3 weeks after your initial appointment 

Dr. Patrick Melese DVM, DACVB & Dr. Crystal Steib DVM
BEHAVIOR HISTORY
(Note: This information is for practice use only and your private information will not be given out without your permission except as required to communicate with parties such as your referring doctor after the appointments) or as required by law.

Date: 			 Owner(s): 								

Owner’s Date of Birth (to access pharmacy prescriptions for pet):__________________________

Address (include zip): 										

Type & size of residence (e.g., 2 story 1800 sq ft house) 			                    		

Yard size & fencing (e.g., medium yard- 6 ft solid wood fence)					

Phone: **H:	________**Cell:__________ other:________ **e-mails:___________________

Family veterinarian: 				 Referred by: 					

Behavior problems can sometime be difficult, frustrating problems to correct. The information you provide is very important for diagnosing and treating your pet's behavior problems.  Please fill out this form as completely & accurately as possible (“help us help you”). If questions clearly do not apply (e.g., obedience training for cats) you are welcome to skip the question, but please answer all those possible, even if you feel it may not be relevant!  Compose answers to assist the doctors in picturing what is happening (descriptive details). Please be sure to get this and other paperwork (e-mail to info@sdvetbehavior.com or FAX) to us ASAP since they are required to offer you a new-patient appointment along with your scheduling fee. Take videos (upload to “cloud” and send us a link) of problem behaviors if safe & possible and you feel they are important for doctor to see and they are likely not to be seen during the appointment. We strongly advise you have a way to audio-record the appointment (most “smart” phones have this function e.g., “Voice Memo/Voice recorder” app) and be sure you know how to use it! If you wish to send additional info in narrative form, please do so BUT that does NOT substitute for filling out the form completely (i.e., “see narrative” vs. concisely entering in our form does NOT work well).  Thank you.

GENERAL INFORMATION

Pet's name: 				Dog: 	    Cat: 	     Other: 	 Age: 	     years   Sex:  M  F  
Breed:			    Color: 			 Weight: 	 Date of Birth: ____________

Neutered / Spayed:  [  ] yes  [  ] no.    At what age? 							

Where did you obtain this pet?   friend, breeder, private ad, pet shop, shelter, rescue, other: 		

At what age: 												 

For what purpose was this pet obtained?  Companionship, protection, breeding, show, other: 		

Time spent indoors: 					 %    outdoors: 					 %

Is this pet left alone during the day? 				   How long? 				

In precisely what area of the house or yard is the pet kept:

a.	during the day:											
b.	during the night (describe exactly where pet sleeps); 						
c.	when pet is left alone (where is pet?):								
d.	when guests visit: 											

Describe the pet's personality: 										

Diet:		 % dry    		Brand: 								
		 % canned	Brand: 								
		 % table scraps	Supplements: 							

When is the pet fed?  morning  noon  night  other 		 By whom? 				

How long is food left down for pet?	  N/A: pet gulps down immediately: 		

Describes the pet's behavior:

a.	just prior to your departure: 									

	b.   just after your return: 										

List all major surgical or medical problems and approximate dates: 					

List all medication (including dose details) currently being taken by this pet: 			_______

													

List the Names, Ages and Gender (and whether neutered/spayed) of the other pets in the household:

Name				 Breed	Age		Age Adopted	Gender	Spayed/ Neutered?									              		 (and at what age)

												

\What toys does your pet like to play with?  								

What amount of exercise or opportunity to exercise is given to your pet? 				

													

Has this pet had any obedience training? 	  Please describe the type of training and the outcome including age when started and which trainer: 									

What training aids (e.g., type of collar/leash, etc.) do you use on your dog:_____________________
____________________________________________________________________________________ 												
What will the pet do on command? 									

What will the pet do on command when distractions present? 						

Does this pet get along with other animals? 		  If not, please explain: 				

What are the names, ages and relationship to owner (e.g., spouse, son, roommate, etc.) of the people that are in the pet's environment (“family members” including family member filling out form)?  What are their daily schedules? 													_________________________________________________________________		

													

How does this pet react to strangers? 									

How does this pet likely to behave at the Veterinary Hospital? ___________________________________

BEHAVIOR PROBLEM INFORMATION

Please concisely describe your pet's behavior problem(s) (prioritize if multiple): 				

													

													

What month/year was the main problem first noted? 							 

Where and under what circumstances was each problem first noted? 					

													

Describe the situation(s) in which the main problem is most likely to occur? 				

													

The main problem occurs (check off answer):  always        usually         rarely        never  (check below or %)
1.   When the pet is left alone at home:		 		 
2.   In the presence of the family members:		 		
3.   During the night when the family sleeps:		 	 	
4.   Family home but not watching pet:

Frequency of occurrence: 		times per day, 		times per week,		times per month, 	times per year.

Has there been a change in the frequency or appearance of the problem? 		Please describe:

													

What has been done so far to correct this problem? (e.g.: discipline, confine, obedience training, avoid, etc.)

													

What was the pet's response to the specific intervention(s) above? 					

													

Were there any significant changes in this pet's environment prior to the appearance of this problem (circle if seen and comment as needed)?
a.	moved or redecorated	e.	change in family schedule
b.	boarded	f.	new family member/roommate
c.	visitors (human or pet)	g.	diet change
d.	type of litter changed	h.	other (new pet introduced, etc.)

How did these changes affect your pet? 							

Please indicate any other behavior problems (circle and comment as needed):
a.	house soils	 h.	shy	 o.	play			v.  fear of noises
b.	chewing	 i.	eats stool	 p.	jumps up		w. growls at people
c.	feeding	 j.	pacing	 q.	unruly		x. other 		
d.	sexual	 k.	aggressive	 r.	bites
e.	grooming	 l.	barking	 s.	fights
f.	digging	 m. very slow learner	 t.	runs away
g.	eats nonfood items	 n. 	sleep problems	 u.	ignores commands
Comments?: 											

If pet is aggressive, please describe all situations which are likely to elicit aggressive behavior such as growling, nipping, biting, attacking, etc. (e.g., at veterinary clinic or groomer, petting, approached by anyone, approached by children, only when in the car, reaching for, punishing, pushing, taking food or toys away, grooming, handling feet/ears, disturbed while sleeping, at veterinary clinic, etc.): 		   				

													

													

Also: Please discuss in detail any other information which you feel is relevant to your pet's problem:

													

Has your pet bitten a person or other animal?_______________If so, how many times?_______________
How many of the bites have resulted in need for medical attention (how severe?)____________________
_____________________________________________________________________________________

Please describe the last two or three “incidents” (and/or most significant incidents) in detail (and indicate approximate dates) below and on the back of this page. If your pet is not aggressive you can describe incidents you feel are important for the doctor to be aware of.  (If you write on the back remember to send the back also if you have written on it and you e-mail or FAX in paperwork!). 

													

													

													

													

													

													

Once you have completed these forms (it is very helpful to receive Rtf/word-processor file of the forms if completed on your computer so that they may be added directly into your pet's behavioral chart) please e-mail to info@sdvetbehavior.com or Fax them to our office!