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Feline Behavior History Form
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Feline Behavior History Form
Please enable JavaScript in your browser to complete this form.
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Step
1
of 7
Client Name
*
First
Last
Email
*
Phone
*
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Patient Name
*
Breed
*
Age
*
Gender
*
Male
Female
MEDICAL HISTORY
Is your cat spayed/neutered?
*
Yes
No
If yes, at what age was the surgery performed?
*
Reason for spay/neuter?
*
Routine
Attempt to modify behavior
Other
Were there any changes ofter the procedure?
*
Yes
No
Briefly describe your cat’s medical history:
*
Current medications (including preventives and any supplements):
*
Next
BACKGROUND INFORMATION:
When did you adopt your cat?
*
How old was your cat at the time of adoption?
*
Where did you get your cat?
*
Shelter
Rescue/Foster
Breeder
Other
Is this your cat’s first home?
*
Yes
No
How many previous homes?
*
Do you know why he/she was given up?
*
Which traits describe your cat as a kitten? Check all that apply.
*
Friendly
Outgoing
Shy
Fearful
Aggressive
Playful
Is this your first cat?
*
Yes
No
How did you select this particular cat over the others?
*
Describe the temperament of your cat’s mother. Check all that apply.
*
Friendly
Shy
Aggressive
Unknown
Describe the temperament of your cat’s father. Check all that apply. (copy)
*
Friendly
Shy
Aggressive
Unknown
Do you know the status of your cat’s littermates?
*
Next
HOME ENVIRONMENT
Describe your home:
*
single family house
town house/multifamily home
apartment/condo
other
Have you relocated since you’ve owned this cat?
*
Yes
No
Please list approximate date(s)
*
Please list all members of your household and include their age if under 18:
*
Describe your cat’s relationship to the other members of the household:
*
Please list all household pets in order adopted, including species, breed, gender, age, and age at adoption:
*
Describe your cat’s relationship to the other household pets:
*
Next
MANAGEMENT
Please describe a typical 24-hour day in the life of your cat:
*
Does your cat run unsupervised outdoors?
*
Yes
No
Do you have an outdoor containment system?
*
Yes
No
Where does your cat sleep at night?
*
Who wakes up first?
*
You
Your cat
Other
Where is your cat’s favorite resting spot when you are home?
*
Describe your cat’s favorite toys:
*
Describe any interactive games that you play with your cat and note frequency:
*
Does your cat perform any special tricks?
*
How often do you brush your cat?
*
Daily
Weekly
Occasionally
Never
How often does your cat groom himself/herself?
*
Occasionally
Excessively
Does your cat usually follow you from room to room?
*
Yes
No
Does your cat have free access to the house when you leave?
*
Yes
No
How does your cat behave when you prepare to leave home? Check all that apply.
*
No reaction
Looks “sad”
Hides
Aggressive behavior
Vocalizes
Other
How does your cat behave when you return home? Check all that apply.
*
No reaction
Calm greeting
Brief excitement
Hides
Other
Does your cat use a scratching post?
*
Yes
No
What type of scratching post?
*
List any items that your cat chews or scratches, if applicable:
What do you feed your cat (brand and specific formula)?
*
How long have you been feeding this diet?
*
How much do you feed?
*
How many meals per day?
*
One
Two
Three
Food is left out at all times
Which family member(s) is/are responsible for feeding?
*
Location of food bowl:
*
Kitchen
Laundry
Basement
Other
What are your cat’s favorite treats?
*
Describe your cat’s reaction to thunderstorms:
*
No reaction
Hides
Follows person
Please describe your cat’s overall activity level:
*
Excessive
High
Moderate
Low
Very Low
Next
BEHAVIORAL DETAILS
Please describe your main behavioral concern:
*
Describe a typical episode:
*
The behavior occurs:
*
Daily
Weekly
Monthly
PLEASE ANSWER THE FOLLOWING QUESTIONS FOR THE MAIN PROBLEM
When did you first notice the problem?
*
Describe the earliest incident you can recall:
*
Describe the most recent episode (include approximate date):
*
Please describe several representative episodes. Include details such as date, your cat’s posture (tail, ears) and any vocalization such as hissing or growling.
*
Has the frequency of the behavior:
*
Increased
Decreased
Remained unchanged
Has the intensity of the problem:
*
Increased
Decreased
Remained unchanged
Indicate any changes in the status of household pets that occurred within 3 months of the onset of the problem:
*
Additional pet(s)
Loss of pet(s)
Illness in pet(s)
Indicate any changes in the status of household people that occurred within 3 months of the onset of the problem:
*
New household member(s)
Loss of household member(s)
Pregnancy
Illness
Indicate any changes of employment status that occurred within 3 months of the onset of the problem:
*
New location
Working from home
Working remote
New work schedule
Any other changes that occurred within 3 months of the onset of the problem?
What measures have you taken to manage the behavior?
*
Please subjectively rate your perception of the main behavior problem:
*
The behavior is not serious, I am just curious
The behavior is a nuisance but tolerable
The behavior is a serious problem but I would keep my cat if the behavior persists
The behavior is not tolerable and I may rehome my cat if the behavior persists
The behavior is not tolerable and I may euthanize my cat if the behavior persists
Please briefly describe any additional behavioral problems or concerns you experience with your cat:
Next
AGGRESSION SURVEY
Has your cat bitten anyone?
*
Yes
No
What was the age of your cat and circumstances surrounding the first bite?
*
How many bites required medical attention?
*
Who was bitten?
*
Which of the following has your cat bitten?
*
Hands
Arms
Legs
Face
Chest
Buttocks
Other
Is your cat’s aggression predictable?
*
Yes
No
Do the attacks appear unprovoked?
*
Yes
No
Is your cat docile afterward?
*
Yes
No
Is your cat disoriented afterward?
*
Yes
No
Does your cat appear sorry afterward?
*
Yes
No
Did you notice a glazed expression before/after the bite?
*
Yes
No
Next
SOCIAL INTERACTIONS
How does your cat react to cats seen outside the window? Check all that apply.
*
Ignore
Hiss
Growl
Urinate
Run away
Other
How does your cat react to being brushed? Check all that apply.
*
Purr
Growl
Hiss
Bite
Swat
Tolerates it
Loves it
How does your cat react to being petted by familiar people? Check all that apply.
*
Purr
Growl
Hiss
Bite
Swat
Tolerates it
Loves it
How does your cat react to being held in arms or lap? Check all that apply.
*
Purr
Growl
Hiss
Bite
Swat
Tolerates it
Loves it
Describe your cat’s behavior toward familiar visitors to your home:
*
Aggressive
Friendly
Shy
Hides
Describe your cat’s behavior toward unfamiliar visitors to your home:
*
Aggressive
Friendly
Shy
Hides
Describe your cat’s behavior toward children who visit your home:
*
Aggressive
Friendly
Shy
Hides
Under what circumstances does your cat meow?
*
Under what circumstances does your cat hiss?
*
Under what circumstances does your cat growl?
*
Does your cat mount people, other animals, or inanimate objects?
*
What is it like to medicate your cat?
*
Easy, pop in the mouth
Hide the meds in food
Impossible
Never tried
Submit