These forms, and their submission to us, are intended only for those pet owners who have scheduled an appointment with Chicagoland Veterinary Behavior Consultants (CVBC).This information will not be evaluated unless an appointment has been scheduled and is typically read the day of the appointment.

The following forms are utilized by Chicagoland Veterinary Behavior Consultants (CVBC) in order for us to collect preliminary information regarding your pet's behavior problem. They are designed to provide as much concise information as possible. Please refrain from trying to include additional historical information beyond what the forms are asking for. We will be discussing the full details of your pet's behavior at the time of the consultation.

Once you have completed these forms, save them on your computer, then attach them to an email which can be sent to both Dr. Ciribassi at drjdvm@gmail.com and Pat Rattray (behavior assistant) at boxermom47@gmail.com.


Canine History Forms

Canine General History Form

Canine Aggression Screen (Used only when aggression is a component of the behavior)

Feline History Forms

Feline General History Form

Feline Elimination Form (Used only when the cat is eliminating outside the litter box)


Veterinary Form

Veterinary History Form

Note: Please have your veterinarian complete this form and faxed to the number on the form PRIOR to your appointment. Be sure they include ANY laboratory results so that we do not have to repeat these tests at our office.

General Forms

Liability Form  Note: This form can be printed, completed and brought with you to the appointment if it is easier

Photo/video/records release form

Appointment Letter

CVBC Brochure

Note: These forms are for your information only