Feline Behavior History Order Number General Information Client's Name * Address * ZIP Code * Home Phone Work/Day Phone Email Address * Name of Pet * Breed * Pet's Date of Birth * Sex * Male Female Neutered/Spayed * Yes No Regular Veterinarian - Doctor Clinic Name Clinic Address Clinic Phone Clinic Fax Behavior Problem What is the main behavior problem or complaint? How much of a problem is this behavior? How serious are other behavior problems? Please list behaviour problem, very serious, serious, or not serious. When did you first notice the main problem (age of cat)? Describe the chronology of the behavior problem, i.e. how it developed over time: When did it first become a serious concern? In what general circumstances does the cat misbehave? Problem A Problem A Frequency Problem B Problem B Frequency Problem C Problem C Frequency Has this problem changed in frequency? Please describe. Has this problem changed in intensity? Please describe. Has this problem otherwise changed? Most recent incident Most recent incident date Second to last incident Second to last incident date Third to last incident Third to last incident date Other significant incidents What have you done so far to try to correct the problem? How do you discipline your cat for this problem? Elimination Behavior Does your cat use a litter pan? Yes No How did you litter train your cat? Does your cat ever eliminate in the house but outside the litter pan? Yes No If yes, does your cat urinate, defecate, or both? Urinate Defecate Both How many litter pans do you have? Where are they? Please be specific: which room, which floor. What kind of pans are they? Please indicate number for commercial pan, removable lip, covered box, dishpan, cardboard box, or other. How old is each pan? Do you use a liner? If yes, what type? What kind of litter is used? Please be specific. Have you recently changed brands? How often is litter scooped? How often is litter replaced? How do you clean the box(es), and how often? Please be specific. Does the cat cover urine and feces in the box? Cat's Background Why did you decide to get a cat? Where did you get this cat? SPCA Breeder - newspaper ad/flyer Breeder - referral Pet store Friend Stray Other Other source Have you owned cats before? Yes No How old was the cat when acquired? How many animals were there to choose from? How many littermates, if known? Number of littermate females Number of littermate males Why did you decide to get a cat? Why this particular breed, sex, color? Why did you choose this cat over the others? Please be specific. Describe your cat's behavior as a kitten: Has this cat had other owners? Yes No If yes, how many? How long have you had this cat? If yes, why was the cat given up? Diet and Feeding What do you feed your cat? Please be specific, e.g. brand name. Has your cat's appetite increased, decreased, or had no change? How much do you feed? Please be specific. How often and when is it fed? Where is he/she fed? Where does your cat drink? Who feeds the cat? What is your cat's favorite treat? Home Environment People living in household, including yourself. Please include name and hours away from home. Animals in household. Please include name, species, breed, sex, age obtained, and age now. In what sequence were the above animals obtained? What is your cat's relationship to the other animals? Please describe. What type of area do you live in? City Suburbs Rural What type of house do you live in? Apartment - studio or 1 bedroom Apartment - 2+ bedrooms Duplex/attached house House - single family Trailer Farm Other Have you moved since acquiring your cat? Yes No If yes, how many times? Has your household changed since acquiring your cat? Yes No If your household has changed, please describe. Daily Schedule How do you play with your cat? Does your cat go outdoors? Yes No Is your cat supervised when outdoors? Yes No Does your cat use a pet door? Yes No How does your cat signal to go outside? Is your cat harness/leash trained? Yes No Percentage of time indoors Percentage of time outdoors Social Behavior Where does your cat sleep at night? Does your cat sleep more, less, or the same? Where is your cat when you have guests? How does your cat behave with adult visitors? How does your cat behave with visiting children? How does your cat behave with the veterinarian? Where is your cat when alone in the house? How does your cat behave when you return? How does your cat respond to cats seen out of the window or in the yard? When does the cat meow? When does the cat hiss or growl? What toys does the cat have? Does your cat carry toys/objects or mother other animals? Yes No What is your cat's activity level in general? Low Average High Excessive How would you describe your cat's personality? Sexual Behavior At what age was your cat neutered/spayed? Why was this done? Were there any behavior changes after neutering? Does your cat mount other cats? Yes No Does your cat mount animals? Yes No Does your cat mount people? Yes No If yes, who or what is mounted? If your cat is intact, has he/she ever been bred? Yes No If you have a female, was she a good mother? Yes No Are you planning to breed your cat in the future? Yes No Grooming Does your cat groom, lick or bite himself excessively? Yes No Is your cat declawed? Yes No If yes, declawed in the front only or all four paws? Front only All four paws Did the paws become infected after the surgery? Yes No What was the immediate aftercare? Did your cat use this litter? Does your cat use a scratching post or favorite scratching area? Please describe. Medical History Is your cat on any medication now? Has your cat been on medication in the past? Problem Seriousness Where are you on a scale of 1 to 5? 1 - I am here only out of curiosity - problem is not serious. 2 - I would like to change the problem, but it is not serious. 3 - The problem is serious and I would like to change it, but if it remains unchanged that's all right. 4 - The problem is very serious and I would like to change it, but if it remains unchanged I will keep my cat. 5 - The problem is very serious and I would like to change it; if it remains unchanged I will have my cat euthanized or give him/her up. Comments Additional Information to Submit with History If you have photos to share that you think would be helpful, please email those photos to support@myanimalandbird.com.
