DVM2DVM Client Referral and Consent to Treat

This is the referral form for a DVM2DVM Consultation where:

Your client will meet with our Doctor for a 30 minute virtual appointment
- This is the ONLY direct communication the client will have with our Doctor
You are encouraged to join for the entire appointment or at least, the last 10-15 minutes
- Our Doctor will hand off a treatment plan to you during this time
- If you are not able to be present, an additional must be scheduled
- Recommendations are provided by email to you and the client
You will be responsible for implementing the treatment plan
- Prescribing & maintaining prescriptions
- Performing exams and lab testing
- Reaching out to TBC if there are concerns or questions
Our team is available for virtual training or behavior therapy to all DVM2DVM patients

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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