Please print (see instructions in the blue box on the right) and answer the following questions to the best of your ability as
it relates to your cat(s) and his/her behavior issue.
When filling
this out for a phone consultation, please fax (770) 579-6013 or mail
it back to us as
soon as possible. If your cat has an appointment to rule out medical
conditions, please bring this history with you.
Please keep in mind
that we offer our behavior services to help cats and their families
stay happy and together. In most cases we are able to resolve or
greatly improve the problem by addressing both the medical and
behavioral aspects simultaneously. We have an overwhelming response so
please be patient with us. You will always receive a call back.
Print this page and fax or mail it to us
for a phone consultation
or bring it with you to your appointment.
Printing Instructions
Use your browser's File - Print Preview option
to print this questionnaire.
It will be approximately 6-8 pages
General Information
Client’s name:
Address:
Home phone:
Work phone:
Name of pet:
Breed:
Date of birth:
Age:
Sex:
Neutered/Spayed?
Is your cat declawed?
If yes, front only or all four paws?
If yes, were there any complications with the
surgery (i.e. infection)?
Does your cat go outdoors?
If yes, what percentage of time does your cat
spends outdoors?
Is access limited? (i.e. leash, cat door,
balcony/deck)
Do any of your other cats have access to the
outdoors?
What brand of food does your cat currently eat?
Do you feed dry food? Do you feed canned food?
How do you feed your cat? (i.e. food out all the
time, meals, timed feeder, etc)
What is your cats favorite treat?
Who referred you to us?
Who is your regular veterinarian?
Dr.:
Clinic name:
Address:
Phone:
May we contact them for your records?
Have you visited this veterinarian for this
problem?
Cat’s Background
Why did you decide to get a cat?
Why this particular breed, sex, color?
How old was the cat when it was acquired?
Where did you get this cat? (i.e. SPCA, Humane
Society, Pet Store, Breeder, Friend, Stray, Gift, etc.)
If known, describe your cat’s behavior as a kitten.
Has your cat had other owners?
If known, how many?
Why was the cat given up?
How long have you had this cat?
Behavior Problem
What is your main behavior problem or complaint?
When did this problem start?
Do you recall anything specific at the onset of the
behavior problem? (i.e. moving, birth of a child, houseguests,
construction, parties, etc.)
How frequently does the problem (or problems)
occur?
Has the problem changed in frequency or intensity?
What have you done so far to correct the problem?
How do you discipline your cat for this problem?
Rate this problem on a scale of 1-10 (10 being the
worst).
Are there any secondary problems or concerns?
Elimination Behavior
How often does your cat use the litter box?
Occasionally
Never
Only urinates
Only
defecates Always
If your cat does not consistently use the liter
box, where in the house are they eliminating?
How many times a day does your cat urinate?
Describe the size of the urine clumps.
How many times a day does your cat defecate?
Describe the stools (size of fecal balls, amount, firm, soft, formed,
runny, etc.).
How many litter boxes do you have?
What type of litter boxes are they (check
and indicate number)
Commercial litter box (size: )
Commercial litter box with removable “lip”
Covered box, “cave”-type front door
Covered box, “Booda” type (cat crawls into hole)
Automatic litter box (i.e. Littermaid)
Other (please describe)
How old is each litter box?
Where are the litter boxes?
Do you have a pet door leading to the litter box
area?
What brand of litter do you use?
What type of liners do you use?
How often do you scoop the litter box?
How often do you completely empty and scrub the box
clean?
What type of cleaning products do you use?
Do you then refill it with clean litter?
What type (Check all that apply):
Scoopable/Clumping
Non-scoopable
Scented
Unscented
Crystal
Pine
Other
(Please describe):
If litter is non-scoopable, do you scoop out urine
or mix it in with the remaining litter?
How long have you been using this brand?
Do you change brands often? If yes, what other
brands have you tried?
Does your cat dig in the litter before eliminating?
Does your cat cover urine and feces in the litter
box?
Does you cat squat, stand or perch on the edge of
the box when eliminating?
Do you add deodorizers to the box (i.e. baking
soda)?
Do you have a litter step out matt, other tray or
newspapers around the litter boxes?
Home Environment
Please list all people, including you, living in
the household include ages and their relationship/role in caring for
the cat:
Please list all animals in the household, include
ages, breeds and any information you feel may be relevant:
What is your cat’s relationship to the other
animals (i.e. friendly, hostile or fearful)? Please describe.
Have you moved since acquiring your cat?
If yes, how many times?
Where does your cat sleep at night?
Do you have any areas if your home that are off
limits to the cat(s)?
If so, where? Why?
Have they always been off
limits?
Are they allowed in these areas some of the time
and not others?
Social Behavior
Where is your cat when alone in the house?
How does your cat behave when you return home?
Where is your cat when you have guests?
How does your cat behave with adult visitors?
How does your cat react to visiting children?
How does your cat respond to other cats seen out of
the window or in the yard?
How does your cat behave at the veterinarian?
How would you describe your cat’s overall
personality?
When does your cat hiss or growl?
Does your cat bite you?
If yes, what are you doing when this happens?
Does your cat scratch you?
If yes, what are you
doing when this happens?
Does your cat vocalize?
If yes, does it happen excessively?
At what time of the day?
Play Behavior
What is your cats overall activity level?
What toys does your cat prefer?
Does your cat carry toys/objects around the house
or “mother” other animals or objects?
Does your cat chew/suckle/lick strange objects or
clothing?
How do you play with your cat?
Does your cat have a favorite scratching post or
scratching area?
If yes, please describe the post or area. Include height, substrate
and location.
Do you have cat trees?
If yes, please describe the type of condos, where they are located and
if your cats use them.
Do you trim you cat’s nails?
Does your cat scratch on anything you wish he/she
would not?
Sexual Behavior
At what age was your cat spayed or neutered?
Were there any complications with the surgery?
Were there any behavior changes after the surgery?
Does your cat mount other cats, objects or people?
If female, does your cat vocalize, flag her tail
(whipping from side to side) or tread (make biscuits) with her back
feet?
If your cat is “intact” has he/she ever been bred?
Are you planning to breed your cat in the future?
Grooming Behavior
Does your cat groom, lick or bite himself
excessively?
Does your cat have bald patches? If yes, where are
they located?
Does your cat’s skin ripple or twitch?
Does this happen after petting or without being
touched at all?
Does your cat chew or suckle its tail?
Would you say your cat is a good groomer? (i.e.
coat is well maintained without you having to brush or bathe it)
Daily Routine
Have there been any changes in your routine lately?
Have any recent activities been stressful to your
cat? (i.e. parties or construction)
Who feeds your cat?
Where does your cat drink?
Do you find he/she drinks excessively?
Do you find your cat has difficulty navigating the
household? (i.e. jumping on the bed, climbing the stairs, tend to stay
in one location/one floor, etc.)
Is your cat currently on any medication?
Has your cat been on medications in the past?
If
yes, please list the medication, dosage and what it was prescribed
for.
If this problem continues, I will:
Ignore it
Continue to seek help and work on the problem
Give my cat away
Put my cat outside
Euthanize my cat
Home Diagram
Please provide a diagram of your house. A basic
floor plan using simple boxes is sufficient. Please be sure to include
the following: location of litter boxes, food, water, cat trees,
access to windows, doorway thresholds between rooms, rooms that cat is
not allowed access to and be sure to notate any soiled areas if you
are filling this out for elimination issues.
