(918) 299-1208 |  9360 S. Union Ave Tulsa, Oklahoma 74132 Request Appointment

Woodland West Animal Hospital

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Canine Consultation Questionnaire

  • Owner Information

  • Preferred local pharmacy:

  • Basic Canine Information

  • Date and age when acquired (if known):
  • Date Format: MM slash DD slash YYYY
  • Canine Medical History

    *Please ensure that we have all your pet's medical records
  • Date Format: MM slash DD slash YYYY
  • The most recent set of vaccinations received and date ( select all that apply ) :
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Provide medical history (infection/surgeries) and prescribed treatment:
  • Current/ regular medications (Such as allergy, heartworm, herbal, over the counter, pain medication, supplements, topical flea and tick treatment ) :
  • Has there been any change in the following?
  • If so, describe treatment
  • Current Human Household Members

  • Other Household Pets

  • Current pets in the household :
  • Training

  • Diet and Feeding Habits:

  • Daily Activities

  • Interaction With Family Members

  • Reaction to handling:
    Does your dog exhibit any aggression in the following circumstances? This can include growling, snarling, lunging, nipping, snapping, showing teeth, or even biting. If biting occurs, please specify whether tear puncture, or bruising is involved:
    Fill out the following tables depicting your dog’s typical reaction:
    In each box, describe the type of aggression (e.g., growling, snarling) that may be exhibited in each situation, even if it does not occur every time.
  • Interaction With Others

  • Are there any regular visitors to the home? If so, please provide the information requested:
  • What is your dog’s response to frequent, occasional, and rare visitors?
  • Dog’s reaction to :

  • Inside the home :

  • Outside the home :

  • Other Behaviors

  • The Current Problem

  • Aggression Section ( if applicable )

  • Relationship with Canine

  • How would you describe your own and your family’s relationship with this dog?
  • What are your own and your family’s feelings about the dog’s present behavior?
  • Video Recordings

  • Video recordings of the specific problem behaviors are extremely helpful for verifying your descriptions. Never place any person or animal in danger in order to obtain video information. Feel free to bring the video recordings with you (on your phone, tablet, laptop, etc.) to your consultation. Please do not email videos ahead of time.
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  • AAHA Accredited
  • About Us
    • Meet Our Management
    • Meet Our Reception Staff
    • Meet Our Technical Staff
    • Meet Our Veterinarians
    • Virtual Tours
    • Volunteer With Us!
  • Accessibility
  • Autoclave Training Videos
  • Canine Consultation Questionnaire
  • Contact
    • Get Directions
    • Management Email
    • Veterinarian’s Email
  • Contact Anna Woolley, DVM
  • Contact Ashley Hollingsworth, DVM
  • Contact Beka Heinz, DVM
  • Contact David Haynes
  • Contact Ellen Clupper, DVM
  • Contact Jana Bone
  • Contact Jessica Lipstate
  • Contact Karen Miller
  • Contact Meredith Dooley
  • Contact Mike Jones
  • Contact Nick Mosier, DVM
  • Contact Ross Clark
  • Contact Samantha Ketcher
  • Contact Sarah Cockburn
  • Contact Shad Wilkerson
  • Contact Taylor Barranco Form
  • Contact Todd Yeagley
  • Contact Victoria Monaghan
  • Dachshund Dash 2019
  • Dental Consent Form
  • Education
    • Applying Eye Medication
    • Dental Cleaning
    • Disaster Preparedness
    • How To Apply Ear Medication
    • Spay Procedure
  • Employment
    • Download Employment Application
    • Online Employment Application
    • Upload a Resume or Completed Application
  • Feline Consultation Questionnaire
  • Forms
  • Home
  • Laser Declaw Consent Form
  • Memorials
    • Submit A Memorial
      • Upload Photo
  • New Client Information
  • New Clients
  • Office Tour
  • Pay Your Invoice
  • Payment Confirmation
  • Pet Health Articles
  • Pet Insurance
  • Pet Portal
  • Photos
    • 2012 Pet Costume Contest Photos
    • 2013 Halloween Pet Costume Contest
    • 2014 Howl-O-Ween Photos
    • Hospital Virtual Tour
  • QUIZ — Loading the Midmark Autoclave
  • Register
  • Request An Appointment
  • Reviews
  • Sedation Consent Form
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  • SOCKTOBER
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  • Testing
  • Testing 2
  • Thank You!
  • The Dachshund Dash – Watch Your Weiner Run! Presented by Woodland West Animal Hospital and Pet Resort
  • Upload Behavior Forms
  • Veterinary Services
    • Boarding
    • Dental Procedures
    • Digital X Ray
    • Drive Thru
    • Fully Stocked Pharmacy
    • Hospice & Euthanasia Services
    • House Calls
    • Laser Surgery & Therapy
    • Microchipping
    • Nutritional Counseling
    • Orthopedics
    • Parasite Prevention
    • Puppy and Kitten Care
    • Senior Care
    • Surgery
    • Ultrasound
    • Vaccinations
    • Walk-ins
    • Wellness Plans
    • Behavior Consultation Services
    • Financing Options