Feline Behavior Consultation Questionnaire

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Page 1

GENERAL INFORMATION

Name

Date of consultation

Address

Phone: Home

Phone: Cell

Fax:

Veterinarian/clinic:

Clinic phone:

Clinic address

Referred by (if other than veterinarian):

PET INFORMATION

Cat's name:

Breed:

Color:

Date of birth:

Weight:

Sex:

MaleFemale

Neutered?

YesNo

Declawed?

YesNo

Age neutered :

Age at declawing:

Any change after neutering?

Any change after declawing?

Age obtained:

Where did you obtain this pet?

Breeder, if applicable:

Behavior of parents or littermates:

Page 2

REINFORCER ASSESSMENT

If your cat was allowed to have any treat, what would it prefer? List top five:

What other types of rewards would entice your cat (play toys, catnip, attention/affection). List top five:

FAMILY/RELATIONSHIPS

List each family member (include sex and age):

How does your cat get along with each family member?

Who feeds your cat?

Who grooms your cat?

Who gives your cat treats?

Who plays with your cat?

Who trains your cat?

Briefly describe the family schedule, including how long your cat is left alone:

List any other pets in the household including species, breed, age, and sex:

How do the pets get along with each other?

TRAINING

What commands does your cat respond to?

Describe your cat's learning ability:

Who does your cat respond to the best?

List any tricks your cat can perform:

Have you used a body harness on your cat?

YesNo

Cat's reaction:

HANDLING

How does your cat react to the following:

Restraining on your lap:

Nail trimming:

Grooming or brushing:

Giving pills:

Giving liquid medication:

Cleaning/treating ears:

Lifting/carrying:

Patting/stroking:

Bathing:

Page 7

PRINCIPAL COMPLAINT

(It is not necessary to duplicate previous answers for elimination problems or skin disorders)

What is the primary problem? (aggressive, destructive, house soiling, tail chasing, etc.)

Please comment:

When did the problem begin?

What age was your cat when the problem started?

Describe the problem, beginning with the most recent incident:

Describe the first incident:

What do you think caused the problem?

Describe any changes in your home or your cat's health when the problem started:

How often does the problem occur?

Has there been a recent change in severity or frequency?

YesNo

If yes, describe:

What has been done so far to try and correct the problem?

What has been your cat's response?

List any techniques that have been at all successful:

List any techniques that have made the problem worse:

List any drugs (include dosage, frequency, when started, when stopped), dietary treatments, supplements, or remedies tried so far, and your cat's response to medication: