Name: Broadview Animal Hospital
Telephone: +1-
Price range: $$

Feline Behavior

This form is used to give the doctor a solid understanding of your pet’s behavior. Some questions are required (as indicated) and must be answered to complete the form. For best results, please try to answer all questions that are applicable. Please allow at least 30 minutes of time to complete this form as it is very detailed. If you need more time you can save and continue the form by selecting to do so at the very bottom of the form. Do not exit the form without saving or you will need to start it over again. Please note, this form is required to be completed in advance of your pet’s behavior consult appointment.

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Cat's Name(Required)

Date of Birth

Sex(Required)

Neutered / Spayed?(Required)

At what age was your cat neutered or spayed?

Why was this done?

Where there any behavior changes after spay / neuter?

Please describe these behavior changes.

Has your pet ever been bred? Are you planning to breed?

What is the main behavior problem or complaint?(Required)

How frequently does the main problem occur (how many times daily, weekly, monthly)?(Required)

Any additional problems?(Required)

Please list the additional problems.

How frequently do these additional problems occur?

What are your goals for this consultation?(Required)

Chronology of the Behavior Problem

When did you first notice the main problem (age of cat)?

When did it first become a serious concern?

In what general circumstances does your cat misbehave?

Has the problem changed in frequency? Please describe.

Has the problem changed in intensity? Please describe.

Has the problem otherwise changed?

Please describe the most recent incident in detail and indicate when it occurred.(Required)

Please describe the other significant incidents in detail and indicate when each occurred.

What have you do so far to try to correct the problem?(Required)

How do you discipline your cat for this behavior and for any other misbehaviors?(Required)

Have you previously enlisted the help of a trainer or veterinarian for this problem?

Please provide the trainer's or veterinarian's name and what you worked on with them.

What approaches have worked?

What approaches have NOT worked?

Home Environment

Does your cat go outside?(Required)

Is your cat supervised outside?

How does you cat signal to go outside?

Does your cat use a pet door?

Is your cat harness or leash trained?

Do you have other people in the household?(Required)

Please list the people living in your household, and indiate their age and numbers of hours a day they are not at home on average.

Do you have other animals in the household?(Required)

Please list all animals in the household, including the patient, in the sequence in which they were obtained.

If possible indicate species, breed, sex, age obtained, and current age of each.

What is your cat's relationship to the other animals in the household (e.g. friendly, hostile, or fearful)? Please describe.

Have you moved since acquiring your cat?

How many times have you moved?

Has your household changed (i.e addition or loss of people or animals) since acquiring your cat?

Please describe how your household changed?

Cat's Background

Why did you decide to get a cat?

Where did you get this cat?

Have you owned cats before?

Why did you choose this cat over the others? Please be specific.

Has this cat had other owners?

How many other owners? Why was the cat given up?

Diet and Feeding

What do you feed your cat? Please be specific (brand name, flavor).

Has your cat's appetite changed recently?

Who feeds your cat?

Where does your cat eat and drink?

What is your cat's favorite treat?

Elimination Behavior

Does your cat use a litterbox?(Required)

How did you litter train your cat?

How many litter boxes does your cat have?

Where are they located? Please be specific as to which room and which floor of the house.

What kind of litterboxes do you have?

How old are the litterboxes?

Do you use a litterbox liner?

What type of liner do you use?

What kind of litter do you use (scented / unscented, clumping / unclumping)?

Have you recently changed brands?

How often is the litter scooped?

How often is the litter replaced?

How do you clean the box(es), and how often?

Does your cat cover his/her feces and urine in the box?

Social Behavior

Where does your cat sleep at night? Please be specific.

Does your cat greet you when you come home?

Please describe how your cat greets you.

Where is your cat when you have guest?

How does your cat behave with visitors?

How does your cat behave with the veterinarian?

Where does your cat spend most of his / her time when alone in the house?

How does your cat act when he / she sees strange cats outside?

When does your cat meow?

When does he /she hiss or growl?

What toys does your cat have?

Please rate your cat's activity level in general.

How would you describe your cat's personality?

Does your cat know any tricks?

Please describe your cat's tricks.

Situations in which your cat is less likely to obey your commands.

Date of most recent rabies vaccination?

How many years is the most recent rabies vaccination?

Does your cat groom, lick, or bite himself / herself excessively?

Does your cat's skin ripple?

Is your cat declawed?

Is he / she declawed on the front paws only or on all four paws?

Were they any complications following the declaw surgery?

Does your cat have a favorite scratching post or scratching area? Please describe.

Seriousness of the problem

Where are you on a scale of 1 to 5 as follows?(Required)

Please add any other comments you would like to share with the doctor in the space below.

File Upload

Drop files here or

Max. file size: 600 MB, Max. files: 4.

If you have any videos or photos related to the problem behavior, please feel free to upload here. Please do not try to elicit any aggressive behavior for the purpose of obtaining a video. You may also email photos / videos to info@broadviewvet.com if you prefer.

CAPTCHA

Comments

This field is for validation purposes and should be left unchanged.

Behavior Feline