Florida Veterinary Behavior Service

Lisa Radosta DVM, DACVB

PO Box 210636 Royal Palm Beach, FL 33421-0636

Phone: 561-795-9398Fax: 561-795-8537 Email:

BEHAVIOR QUESTIONNAIRE COVER SHEET

Please the attached questionnaire and return it by mail, email or fax (see above). Please return it at least 3 days prior to your appointment.

Helpful Hints for Veterinary Behavior Appointments

Appointments are typically 2 hours in length.
People who interact with the pet regularly and other animals who are involved should attend the appointment. If you have any questions about who should come to the appointment, please call our office.
It would be very helpful have a video of your pet’s behavior if you can safely make one. Do not provoke aggressive behavior in order to make a videotape.
What to bring
Your pet’s favorite food or treat
Your pet’s favorite toy

Questions?

Call: 561-795-9398 Email:

Many questions can be answered online at:

Florida Veterinary Behavior ServiceLisa Radosta DVM, DACVB

RABBIT QUESTIONNAIRE

OWNER INFORMATION

Owner name:

Address:

Home phone: Alternate phone: Email:

How did you find out about us?

Who is your pet’s primary care veterinarian?Clinic name:

PATIENT INFORMATION

Pet’s Name: Breed: Date of Birth:

Sex: M F Neutered/Spayed: Y NHow old was your rabbit when neutered/spayed?

Where did you get your rabbit?

How old was your rabbit when you first acquired him/her?

Has this rabbit had other owners?  Y  N If yes, how many?  1  2  3  4  Unknown

Why was he/she given up by the previous owners?

BEHAVIORAL HISTORY

Please fill out the table below in regard to your pet’s primary behavior problems.

Problem / Age at which problem began / Frequency / Nature of problem
□ Daily
□ Weekly
□ Monthly
□ Yearly / □ Very serious
□ Serious
□ Not serious
□ Daily
□ Weekly
□ Monthly
□ Yearly / □ Very serious
□ Serious
□ Not serious
□ Daily
□ Weekly
□ Monthly
□ Yearly / □ Very serious
□ Serious
□ Not serious

Please give a detailed description of significant representative events of each problem.

Incident – Date:

BITE HISTORY

If your rabbit has bitten someone, please fill out the following section. If not, skip ahead to the next section.

If your dog has ever bitten anyone, please check the total number of bites:

 0  1  2  3  4  5  >5

Please check the number of bites that broke skin:

 0  1  2  3  4  5  >5

Please check the number of bites reported to public health authorities:

 0  1  2  3  4  5  >5

Was there legal action taken against you as a result of the bite(s)? Y N

AGGRESSION HISTORY

If your rabbit lunges, nips, grunts, bites, thumps or otherwise acts aggressively, please fill out the following section. If not, skip ahead to the next section.

Who is your rabbit aggressive toward?

 familiar adults  unfamiliar adults  veterinarian  unfamiliar rabbits

 familiar rabbits  other household pets  familiar children unfamiliar children

Is your rabbit aggressive when

 reached for  spoken to  touched  looked at  bathed nails trimmed

 in your bed  in his bed pushed/pulled lifted held

 examined at the veterinarian’s office eating sleeping

 resting when startled he sees kids

FEARS

If your rabbit has fears that concern you, please complete this section. If not, please skip to the next section.

Please list the major things that your dog is afraid of

DIET AND FEEDING

What is your rabbit fed?

Where is your rabbit fed? How many meals is he/she fed each day?

If other animals eat at the same time, describe the arrangement (e.g., same room, separate rooms, etc)

PREVIOUS TREATMENTS

Please complete the table below in regard to medical treatment to correct the behavioral problem. Include all behavioral medications.

Date / Treatment / Outcome

HOME ENVIRONMENT

Please list the people, including yourself, living in your household. Include the age for children.

Name / Age / Sex / Relationship
(i.e. self, spouse) / Average # of hours away from home per day / Quality of relationship with dog

Please list all the animals in the household in the sequence they were obtained:

Name / Species / Breed / Sex / Neutered? / Age obtained / Age now / Quality of relationship with dog

HOME AND CAGE ENVIRONMENT

Where is your rabbit housed when you are home?

 Inside Garage  Loose  Lanai/porch  In the yard Hutch

 X-pen  Flat/plastic bottom cage  Free Roaming Wire bottom cage

 Room with a baby gate  Room with a closed door

 Inside Garage  Loose  Lanai/porch  In the yard Hutch

 X-pen  Flat/plastic bottom cage  Free Roaming Wire bottom cage

 Room with a baby gate  Room with a closed door

Have you ever used a crate? Y N

If yes, do you continue to use it? Y N

If yes, when do you use it?

EXERCISE, SOCIAL INTERACTIONS AND PLAY

Does your rabbit get outside time?  Y  N If yes, for how many hours per day?

Please describe the arrangement when your rabbit is outside.

How much exercise does your rabbit get each day?

How do you play with your rabbit?

Does your rabbit interact with other animals? If so, which species? What is the nature of their interactions/relationship?

What does your rabbit have to chew on each day?

 Hanging toysBalls Newspaper Wood Hard plastic toys Doesn’t play with toys

 Baskets Cardboard items

MEDICAL HISTORY

Please list current medications that your pet is taking, including supplements.

1. 4.

2. 5.

3. 6.

Please list your pet’s current and previously diagnosed medical problems and how they were treated.

Date of illness / Condition / Treatment (include medication dosage and dates/duration) / Outcome

ELIMINATION BEHAVIOR

Is your rabbit litterbox trained?  Y  N

What type of litter do you use?

Does he/she every urinate or defecate outside of the litterbox?  Y  N

If so, please describe locations and incidents.

Before consulting with the Florida Veterinary Behavior Service, did you

Consult a non-veterinary behavior consultant? Y N

Consult your veterinarian? Y N

Consult a trainer? Y N

Have you considered finding another home for this dog? Y N

Have you considered euthanasia (putting your dog to sleep)? Y N