Michigan Humane Society Pet Behavior Help Line E-mail Submission

1.	Please provide your contact information below so that we may respond to your query. *Indicates required field * Name: Title  First Required  Middle Required  Last Required  Mr. Ms. Mrs. Mr. and Mrs. Miss Dr.         * Email: Required * ZIP / Postal Code: * Phone Number: Required   Yes, I would like to receive e-mail from Michigan Humane Society   Remember me. What's this?
*2.	Question - Required - E-mail address you would like us to reply to:
*3.	Question - Required - Phone number you would like us to call you at:
*4.	Question - Required - When is the best time for us to return your call?
5.	Question - Not Required - How did you learn about the MHS Pet Behavior Help Line? Please select response MHS shelter MHS clinic Yellow Pages Friend Veterinarian MHS Website Other
*6.	Question - Required - What's your pet's name?
*7.	Question - Required - Are you inquiring about a dog or cat? Dog Cat Both Other
8.	Question - Not Required - What breed is your pet?
*9.	Question - Required - What sex is your pet? Please select response Male Female Male/Neutered Femaled/Spayed
*10.	Question - Required - Age of pet? Please state months or years.
*11.	Question - Required - How long have you had pet? Please state months or years.
12.	Question - Not Required - Where did you obtain this pet? Please select response MHS Rochester MHS Westland MHS Detroit Breeder Pet Store Rescue Group Other
*13.	Question - Required - Are there other pets in the household? Yes No
14.	Question - Not Required - If Yes, what type and age are the other pets.
15.	Question - Not Required - Please describe the problem that you're experiencing.
16.	Question - Not Required - When did this behavior first begin?
17.	Question - Not Required - Approximate date of the last vet visit?
18.	Question - Not Required - What was the reason for the last vet visit?