Kat, behaviour tech

Feline Questionnaire

Please fill out the entire form to the best of your ability, prior to your consult with Kat, Behaviour Tech. All sections marked with * are required.

General History

Your name

Phone

Address

City, Province, Postal Code

Family veterinarian/clinic

Pet’s name

Pet’s breed

Pet’s date of birth/approximate age

Sex

Male intact Female intact Male neutered Female spayed

How old was your pet when you brought them home?

Where did you acquire your pet?

Describe the previous home (impressions of littermates, parents, foster home, etc):

What is your primary concern?

Home Environment

List all family members living in the home along with the ages of any children:

List any pets in the home along with ages:

Are there any children who regularly interact with your pet?

Yes No

Does your pet get along with everyone in the household (including other pets)?

Yes No

If no, please describe:

What type of food do you feed your pet?

What type of treats do you give your pet?

What is your favourite thing to do with your pet?

What are three things you love about your pet?

How would you describe your pet’s personality?

Does your cat go outdoors?

Yes No

If yes, describe:

Does your cat climb or play anywhere that is undesirable to you?

Does your cat scratch anywhere that is undesirable to you?

How many litter boxes does your cat have?

Primary Concern

When did this issue start?

How would you describe the severity?

Mild Moderate Severe

Have there been any changes in the home or the pet’s health since the primary problem started?

What do you think caused this problem?

Describe the most recent incident:

Describe the first incident and any other pertinent incidents:

How often does this problem occur?

What have you tried to improve this problem?

Has anything made the problem worse? Better?

Please list any other problems that need to be addressed along with how old your pet was when it started and the severity:

What are your goals for this consult?

Training History

If yes, describe:

Does your cat respond to any cues? (ex. Sit, come, etc)

Other:

How does your cat respond to handling? (nail trims, petting, picking up, ear cleaning, giving medication, etc.)

Does your cat have any significant fears?

Has your cat ever:

Threatened to bite Bitten without breaking the skin Bitten and caused injury None

Describe your cat’s appearance during aggressive incidents (body posture, face, ears, tail, hair)

In what situations has your cat displayed aggression?

List all of your cat’s targets for aggression (people/animals):

Does your cat ever eliminate outside of the litter box?

Yes No

Does your cat groom:

Normally Excessively Decreased amount

Health Status

When was your cat’s last veterinary visit?

Are vaccines up to date?

Yes No

Does your cat have any ongoing medical problems?

Is your cat on any medications or supplements?

Have you noticed any other health issues?

Not sure if I can help?

Send me an email with a brief description of your concern. I’ll be the first to tell you if you need the help of a different professional.

KAT, BEHAVIOUR TECH