Client Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Patient Name *

Breed *

Age *

Gender *

Male
Female

MEDICAL HISTORY

Is your cat spayed/neutered? *

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? *

Briefly describe your cat’s medical history: *

Current medications (including preventives and any supplements): *

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? *

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? *

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? *

HOME ENVIRONMENT

Describe your home: *

single family house
town house/multifamily home
apartment/condo
other

Have you relocated since you’ve owned this cat? *

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: *

MANAGEMENT

Please describe a typical 24-hour day in the life of your cat: *

Does your cat run unsupervised outdoors? *

Do you have an outdoor containment system? *

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? *

Does your cat have free access to the house when you leave? *

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? *

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

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:

AGGRESSION SURVEY

Has your cat bitten anyone? *

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? *

Do the attacks appear unprovoked? *

Is your cat docile afterward? *

Is your cat disoriented afterward? *

Does your cat appear sorry afterward? *

Did you notice a glazed expression before/after the bite? *

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

Feline Behavior History Form