DVM Direct Service Inquiry

This is the referral form for a DVM Direct Consultation where:

You provide our team with the client's email address and basic information to send them a history form
We will set your clinic up in our system for direct payment ($150 per case)
Our Doctor will reach out to schedule a 10-15 min phone call
- They will review the case with you, suggest treatment options, and make recommendations based on the history form
- You implement the treatment plan with the client
Our team is available for training or behavior therapy referrals
- We provide virtual training and coaching

Client Name: * This field is required

Client Email: * A valid email address is required

Client Phone: * This field is required

Reason for referral of this patient to a veterinary behaviorist and signalment: *

This field is required

Referred by: *

This field is required

Practice Phone Number: * This field is required

Practice Address:

This field is required

Street: * This field is required

City: * This field is required

State: * This field is required

Zip: * This field is required

DVM Cell Number:

Preferred contact method to schedule communication with TBC's Doctors:

By completing this referral form and placing my name in the box below, I attest to the physical health of this animal. I am able to provide documentation of a recent physical examination and lab testing performed. I understand that I am responsible for implementing any treatment recommendations and providing follow up care with the patient and client since I maintain a valid Veterinary-Client-Patient Relationship with this animal. It is understood that I will prescribe and adjust medications in conjunction with the recommendations provided by the Veterinary Behaviorist. * This field is required

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The Behavior Clinic
9680 Columbia Road,
Olmsted Falls, Ohio 44138
Information@thebehaviorclinic.com

Phone: 440-334-8534

Fax: 216-920-9990

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