Pre-visit questionnaire for cats

1
Your Name
First Name
Last Name
2
Email
example@example.com
3
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Phone Number
Area Code
Phone Number
5
Date of your appointment
Date
Year
Month
Day
6
Pet name
7
Age or DOB
8
Breed
9
Sex
Male
Female
Male neutered
Female speyed
10
If your cat is neutered
How old was your cat neutered?
Please describe any changes after neutering
11
Your regular vet
12
Insurance provider
13
What type of food do you feed your cat? Please list all the regular food types, eg dry food, tin food, raw meat, home cooked food (please list all ingredients) etc.
Huge
Large
Normal
Small
Ok
Ok
14
Describe your cat's interest/appetite in the regular diet.
Voracious
Good
Average
Poor
Variable
15
What type of treats do you offer?
16
Describe your cat's interest/appetite in the treats.
Voracious
Good
Average
Poor
Variable
17
If you could give any type of treats what would be your cat's favorite reward? List top 5:
18
Other than food, what other rewards (e.g. toy, affection) would be most enticing to your cat? List top 5:
19
List any supplements or additives that you offered or planning to offer.
20
List out all medication(s)
21
List out all allergy(s)
22
Where did you obtain your pet?eg name of shelter, name of breeder, a friend, Gumtree etc.
23
Age obtained?
24
Weaning age
25
Did you meet your pet's parents and littermates? Please briefly describe their behaviour and any other information you noticed.
Huge
Large
Normal
Small
Ok
Ok
26
For what reason did you obtain this pet? Check all that apply.
Companion for family
Companion for other pet(s)
Work
Breeding
Other
27
Describe your cat's personality (check all that apply).
Friendly
Confident
Calm
Timid
Fearful
Aggressive
Noisy/ vocal
Quiet
Excitable
Depressed
Other
28
Was there any behaviour concerns in the early months after your obtained the pet?
YESNO
29
If the above answer was yes, please describe the concerns/ issues.
Huge
Large
Normal
Small
Ok
Ok
30
Please provide details of ALL members in the household.
31
Describe how your pet gets along with each family member including any problems.
Huge
Large
Normal
Small
Ok
Ok
32
Please provide details of ALL pets in the household.
33
Describe how your cat gets along with each pet including any problems.
Huge
Large
Normal
Small
Ok
Ok
34
Describe the usual daily schedule for you and your cat.What's your cat's typical day looks like?
Huge
Large
Normal
Small
Ok
Ok
35
Describe the type of exercise / play sessions you offer including how often, how long and with whom.
Huge
Large
Normal
Small
Ok
Ok
36
What toys or activities do you offer to your cat? How does your cat enjoy it?
37
Do you offer enrichment toys? If yes, what type? How does your pet enjoy it?
38
Describe exploration and scratching behaviour.
Little or no interest
Mostly directed to own toys
Mild household damage
Moderate household damage
Severe household damage
39
If there are damages, describe when, how often, and targets.
Huge
Large
Normal
Small
Ok
Ok
40
*Not required for home visit client. Please provide your home floor plan if possible, and upload some photos of your home, including the cat's resting area, area your cat spends most time at, and the outside.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
41
Where is your cat's preferred sleeping spot during the day?
42
Where does the cat sleep at night?
43
Time your cat goes to bed and wakes up
44
Sleep quality: does you pet sleep well, or moves around often during the night?
45
Have you used a crate or pen to confine? If yes, describe the crate and its location. How often and when do you use it?
Huge
Large
Normal
Small
Ok
Ok
46
Has your cat had professional training or professional behavioural assistance?eg name of trainer, frequency etc.
Huge
Large
Normal
Small
Ok
Ok
47
How would you describe the training? (can choose more than one)
Reward based (praise)
Reward based (food)
Clicker training
Lure training
Correction
Assertive
Other
48
Any tools used for the training mentioned above?
Clicker
Citronella collar
Spray bottle
Tool that make noises (chain, keys, ultrasonic)
Other
49
Have you used a trainer, veterinarian or behaviour specialist for the problem for which you are seeking help today?
Huge
Large
Normal
Small
Ok
Ok
50
What books / DVD / TV shows / YouTube channel have you seen and implemented?
Huge
Large
Normal
Small
Ok
Ok
51
What type of training has been most successful?
Huge
Large
Normal
Small
Ok
Ok
52
Did any training technique make problems worse?
Huge
Large
Normal
Small
Ok
Ok
53
List family member(s) with most control.
54
List family member(s) with least control.
55
How does your cat respond to cues at home?Excellent = in all environments; Good = except for major distractions; Fair = does not listen if distractions; Poor = does not listen without distractions; Never = never taught or performed
Excellent
Good
Fair
Poor
Never
Sit
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Come (indoor)
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Come (in yard)
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Give (drop toy)
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Give (drop stolen item)
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Go to bed/mat/kennel
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Sit
Come (indoor)
Come (in yard)
Give (drop toy)
Give (drop stolen item)
Go to bed/mat/kennel
Excellent
Row 0, Column 0
Good
Row 0, Column 1
Fair
Row 0, Column 2
Poor
Row 0, Column 3
Never
Row 0, Column 4
Excellent
Row 1, Column 0
Good
Row 1, Column 1
Fair
Row 1, Column 2
Poor
Row 1, Column 3
Never
Row 1, Column 4
Excellent
Row 2, Column 0
Good
Row 2, Column 1
Fair
Row 2, Column 2
Poor
Row 2, Column 3
Never
Row 2, Column 4
Excellent
Row 3, Column 0
Good
Row 3, Column 1
Fair
Row 3, Column 2
Poor
Row 3, Column 3
Never
Row 3, Column 4
Excellent
Row 4, Column 0
Good
Row 4, Column 1
Fair
Row 4, Column 2
Poor
Row 4, Column 3
Never
Row 4, Column 4
Excellent
Row 5, Column 0
Good
Row 5, Column 1
Fair
Row 5, Column 2
Poor
Row 5, Column 3
Never
Row 5, Column 4
1 of 6
56
Please indicate if you have used the following training techniques. If you did, how often, and how effective it was
Never
Tried
Used often
Improves
Worsen
Verbal punishment (no, stop)
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Physical punishment (rub nose, hit)
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Pin or roll over
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Shake keys/chain
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Ultrasonic alarm
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Spray water/air/citronella
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Repellent
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Time out
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
Row 7, Column 4
Remote electric collar
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
Row 8, Column 4
Remote citronella collar
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
Row 9, Column 4
Verbal praise
Row 10, Column 0
Row 10, Column 1
Row 10, Column 2
Row 10, Column 3
Row 10, Column 4
Food/treat reward
Row 11, Column 0
Row 11, Column 1
Row 11, Column 2
Row 11, Column 3
Row 11, Column 4
Toy reward
Row 12, Column 0
Row 12, Column 1
Row 12, Column 2
Row 12, Column 3
Row 12, Column 4
Verbal punishment (no, stop)
Physical punishment (rub nose, hit)
Pin or roll over
Shake keys/chain
Ultrasonic alarm
Spray water/air/citronella
Repellent
Time out
Remote electric collar
Remote citronella collar
Verbal praise
Food/treat reward
Toy reward
Never
Row 0, Column 0
Tried
Row 0, Column 1
Used often
Row 0, Column 2
Improves
Row 0, Column 3
Worsen
Row 0, Column 4
Never
Row 1, Column 0
Tried
Row 1, Column 1
Used often
Row 1, Column 2
Improves
Row 1, Column 3
Worsen
Row 1, Column 4
Never
Row 2, Column 0
Tried
Row 2, Column 1
Used often
Row 2, Column 2
Improves
Row 2, Column 3
Worsen
Row 2, Column 4
Never
Row 3, Column 0
Tried
Row 3, Column 1
Used often
Row 3, Column 2
Improves
Row 3, Column 3
Worsen
Row 3, Column 4
Never
Row 4, Column 0
Tried
Row 4, Column 1
Used often
Row 4, Column 2
Improves
Row 4, Column 3
Worsen
Row 4, Column 4
Never
Row 5, Column 0
Tried
Row 5, Column 1
Used often
Row 5, Column 2
Improves
Row 5, Column 3
Worsen
Row 5, Column 4
Never
Row 6, Column 0
Tried
Row 6, Column 1
Used often
Row 6, Column 2
Improves
Row 6, Column 3
Worsen
Row 6, Column 4
Never
Row 7, Column 0
Tried
Row 7, Column 1
Used often
Row 7, Column 2
Improves
Row 7, Column 3
Worsen
Row 7, Column 4
Never
Row 8, Column 0
Tried
Row 8, Column 1
Used often
Row 8, Column 2
Improves
Row 8, Column 3
Worsen
Row 8, Column 4
Never
Row 9, Column 0
Tried
Row 9, Column 1
Used often
Row 9, Column 2
Improves
Row 9, Column 3
Worsen
Row 9, Column 4
Never
Row 10, Column 0
Tried
Row 10, Column 1
Used often
Row 10, Column 2
Improves
Row 10, Column 3
Worsen
Row 10, Column 4
Never
Row 11, Column 0
Tried
Row 11, Column 1
Used often
Row 11, Column 2
Improves
Row 11, Column 3
Worsen
Row 11, Column 4
Never
Row 12, Column 0
Tried
Row 12, Column 1
Used often
Row 12, Column 2
Improves
Row 12, Column 3
Worsen
Row 12, Column 4
1 of 13
57
Has any method mentioned above made the problem worse or led to threats / aggression? Please describe.
Huge
Large
Normal
Small
Ok
Ok
58
How does your cat respond to handling at home?Leave blank if you have not tried
Enjoys
Accepts willingly
Accepts reluctantly
Resists
Threats/Aggression
Nail trimming
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Ear clean
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Eye clean
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Brushing
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Bathing
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Brush teeth
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Pat head
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Rub belly
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
Row 7, Column 4
Hug/Kiss
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
Row 8, Column 4
Lifting
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
Row 9, Column 4
Give medication
Row 10, Column 0
Row 10, Column 1
Row 10, Column 2
Row 10, Column 3
Row 10, Column 4
Removing food
Row 11, Column 0
Row 11, Column 1
Row 11, Column 2
Row 11, Column 3
Row 11, Column 4
Removing toys
Row 12, Column 0
Row 12, Column 1
Row 12, Column 2
Row 12, Column 3
Row 12, Column 4
Nail trimming
Ear clean
Eye clean
Brushing
Bathing
Brush teeth
Pat head
Rub belly
Hug/Kiss
Lifting
Give medication
Removing food
Removing toys
Enjoys
Row 0, Column 0
Accepts willingly
Row 0, Column 1
Accepts reluctantly
Row 0, Column 2
Resists
Row 0, Column 3
Threats/Aggression
Row 0, Column 4
Enjoys
Row 1, Column 0
Accepts willingly
Row 1, Column 1
Accepts reluctantly
Row 1, Column 2
Resists
Row 1, Column 3
Threats/Aggression
Row 1, Column 4
Enjoys
Row 2, Column 0
Accepts willingly
Row 2, Column 1
Accepts reluctantly
Row 2, Column 2
Resists
Row 2, Column 3
Threats/Aggression
Row 2, Column 4
Enjoys
Row 3, Column 0
Accepts willingly
Row 3, Column 1
Accepts reluctantly
Row 3, Column 2
Resists
Row 3, Column 3
Threats/Aggression
Row 3, Column 4
Enjoys
Row 4, Column 0
Accepts willingly
Row 4, Column 1
Accepts reluctantly
Row 4, Column 2
Resists
Row 4, Column 3
Threats/Aggression
Row 4, Column 4
Enjoys
Row 5, Column 0
Accepts willingly
Row 5, Column 1
Accepts reluctantly
Row 5, Column 2
Resists
Row 5, Column 3
Threats/Aggression
Row 5, Column 4
Enjoys
Row 6, Column 0
Accepts willingly
Row 6, Column 1
Accepts reluctantly
Row 6, Column 2
Resists
Row 6, Column 3
Threats/Aggression
Row 6, Column 4
Enjoys
Row 7, Column 0
Accepts willingly
Row 7, Column 1
Accepts reluctantly
Row 7, Column 2
Resists
Row 7, Column 3
Threats/Aggression
Row 7, Column 4
Enjoys
Row 8, Column 0
Accepts willingly
Row 8, Column 1
Accepts reluctantly
Row 8, Column 2
Resists
Row 8, Column 3
Threats/Aggression
Row 8, Column 4
Enjoys
Row 9, Column 0
Accepts willingly
Row 9, Column 1
Accepts reluctantly
Row 9, Column 2
Resists
Row 9, Column 3
Threats/Aggression
Row 9, Column 4
Enjoys
Row 10, Column 0
Accepts willingly
Row 10, Column 1
Accepts reluctantly
Row 10, Column 2
Resists
Row 10, Column 3
Threats/Aggression
Row 10, Column 4
Enjoys
Row 11, Column 0
Accepts willingly
Row 11, Column 1
Accepts reluctantly
Row 11, Column 2
Resists
Row 11, Column 3
Threats/Aggression
Row 11, Column 4
Enjoys
Row 12, Column 0
Accepts willingly
Row 12, Column 1
Accepts reluctantly
Row 12, Column 2
Resists
Row 12, Column 3
Threats/Aggression
Row 12, Column 4
1 of 13
59
List all the problems that need to be addressedPlease list the more important/severe problems first
60
How often do the problems occur?Please describe individual problems.
Huge
Large
Normal
Small
Ok
Ok
61
Has there been a recent change in frequency or severity?
YESNO
62
Describe any changes in the home or your cat's health when the problem first started:
Huge
Large
Normal
Small
Ok
Ok
63
What do you think caused the problem?
Huge
Large
Normal
Small
Ok
Ok
64
Have you considered removing your pet from the home (rehoming or euthanasia) if the problem cannot be improved?
YESNO
65
List each behavioral treatment you have tried, and the cat's response
66
What are your goals for this consultation?
Huge
Large
Normal
Small
Ok
Ok
67
Indicate how your cat reacts to each of the following:
Calm
Friendly
Excited
Ambivalent
Confused
Fearful
Aggressive
Familiar cats
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Unfamiliar cats
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Dogs
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Children
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Familiar people
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Row 4, Column 6
Unfamiliar people
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Row 5, Column 6
Car rides
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Row 6, Column 5
Row 6, Column 6
Familiar cats
Unfamiliar cats
Dogs
Children
Familiar people
Unfamiliar people
Car rides
Calm
Row 0, Column 0
Friendly
Row 0, Column 1
Excited
Row 0, Column 2
Ambivalent
Row 0, Column 3
Confused
Row 0, Column 4
Fearful
Row 0, Column 5
Aggressive
Row 0, Column 6
Calm
Row 1, Column 0
Friendly
Row 1, Column 1
Excited
Row 1, Column 2
Ambivalent
Row 1, Column 3
Confused
Row 1, Column 4
Fearful
Row 1, Column 5
Aggressive
Row 1, Column 6
Calm
Row 2, Column 0
Friendly
Row 2, Column 1
Excited
Row 2, Column 2
Ambivalent
Row 2, Column 3
Confused
Row 2, Column 4
Fearful
Row 2, Column 5
Aggressive
Row 2, Column 6
Calm
Row 3, Column 0
Friendly
Row 3, Column 1
Excited
Row 3, Column 2
Ambivalent
Row 3, Column 3
Confused
Row 3, Column 4
Fearful
Row 3, Column 5
Aggressive
Row 3, Column 6
Calm
Row 4, Column 0
Friendly
Row 4, Column 1
Excited
Row 4, Column 2
Ambivalent
Row 4, Column 3
Confused
Row 4, Column 4
Fearful
Row 4, Column 5
Aggressive
Row 4, Column 6
Calm
Row 5, Column 0
Friendly
Row 5, Column 1
Excited
Row 5, Column 2
Ambivalent
Row 5, Column 3
Confused
Row 5, Column 4
Fearful
Row 5, Column 5
Aggressive
Row 5, Column 6
Calm
Row 6, Column 0
Friendly
Row 6, Column 1
Excited
Row 6, Column 2
Ambivalent
Row 6, Column 3
Confused
Row 6, Column 4
Fearful
Row 6, Column 5
Aggressive
Row 6, Column 6
1 of 7
68
Does you cat react to noises or storm? If so, please describe the reactions.
Huge
Large
Normal
Small
Ok
Ok
69
Does you cat react to the cat carrier and car rides? If so, please describe the reactions.
Huge
Large
Normal
Small
Ok
Ok
70
Does you cat fear of particular locations or situations? If so, please explain and describe the reactions.
Huge
Large
Normal
Small
Ok
Ok
71
After being exposed to a fearful event, how long does it take for your cat to return to normal?You can list out all the triggers
Huge
Large
Normal
Small
Ok
Ok
72
Does your cat have a housesoiling problem?Please describe the age began, frequency, location etc.
Yes
No
Please describe
Urine
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Feaces
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Urine
Feaces
Yes
Row 0, Column 0
No
Row 0, Column 1
Please describe
Row 0, Column 2
Yes
Row 1, Column 0
No
Row 1, Column 1
Please describe
Row 1, Column 2
1 of 2
73
Does your cat have separation related problem for example anxiety, destruction etc.?
Please Select
Please Select
Yes
No
If yes, please describe eg severity, what could be destroyed etc.
74
During the average week, what is the longest time you would need to leave your cat alone?
75
How does your cat react when you prepare to leave?
76
Has your pet ever displayed any of the following?
Yes
No
Who was the target?
Please describe the last incident
Growling/Hissing
Row 0, Column 0
Row 0, Column 1
Familiar people
Unfamiliar people
Dog
Other
Row 0, Column 2
Row 0, Column 3
Bite attempts
Row 1, Column 0
Row 1, Column 1
Familiar people
Unfamiliar people
Dog
Other
Row 1, Column 2
Row 1, Column 3
Bite - released
Row 2, Column 0
Row 2, Column 1
Familiar people
Unfamiliar people
Dog
Other
Row 2, Column 2
Row 2, Column 3
Bite - no release or multiple bites
Row 3, Column 0
Row 3, Column 1
Familiar people
Unfamiliar people
Dog
Other
Row 3, Column 2
Row 3, Column 3
Swipping
Row 4, Column 0
Row 4, Column 1
Familiar people
Unfamiliar people
Dog
Other
Row 4, Column 2
Row 4, Column 3
Growling/Hissing
Bite attempts
Bite - released
Bite - no release or multiple bites
Swipping
Yes
Row 0, Column 0
No
Row 0, Column 1
Who was the target?
Familiar people
Unfamiliar people
Dog
Other
Row 0, Column 2
Please describe the last incident
Row 0, Column 3
Yes
Row 1, Column 0
No
Row 1, Column 1
Who was the target?
Familiar people
Unfamiliar people
Dog
Other
Row 1, Column 2
Please describe the last incident
Row 1, Column 3
Yes
Row 2, Column 0
No
Row 2, Column 1
Who was the target?
Familiar people
Unfamiliar people
Dog
Other
Row 2, Column 2
Please describe the last incident
Row 2, Column 3
Yes
Row 3, Column 0
No
Row 3, Column 1
Who was the target?
Familiar people
Unfamiliar people
Dog
Other
Row 3, Column 2
Please describe the last incident
Row 3, Column 3
Yes
Row 4, Column 0
No
Row 4, Column 1
Who was the target?
Familiar people
Unfamiliar people
Dog
Other
Row 4, Column 2
Please describe the last incident
Row 4, Column 3
1 of 5
77
If there was display of aggression, what is the potential for injury?
None
Minimum (superficial scratches, no medical attention needed)
Moderate (deep or infected wounds, require medical attention)
Severe (target the face/neck, life threatening)
Other
78
After your cat has bitten or caused injury how do you handle the situation and what is your cat's reaction?
Huge
Large
Normal
Small
Ok
Ok
79
If necessary, could you predict and avoid or prevent all situations in which aggression might arise?
YESNO
80
Are there children or people with mental or physical challenges at risk for aggression?
YESNO
81
Have you considered removing your pet from the home (rehoming or euthanasia) if the problem cannot be improved?
YESNO
82
Please check if your pet exhibits any of the following behavior. If undesirable, please comment:
None
Occur, no concerns
Occur, want to improve
Describe
Night waking
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Spinning/ tail chasing
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Licks objects
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Excessive grooming
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Staring
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Stargazing
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Fly chasing
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Mounting
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
Masturbation
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
Ingest non food objects
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
Night waking
Spinning/ tail chasing
Licks objects
Excessive grooming
Staring
Stargazing
Fly chasing
Mounting
Masturbation
Ingest non food objects
None
Row 0, Column 0
Occur, no concerns
Row 0, Column 1
Occur, want to improve
Row 0, Column 2
Describe
Row 0, Column 3
None
Row 1, Column 0
Occur, no concerns
Row 1, Column 1
Occur, want to improve
Row 1, Column 2
Describe
Row 1, Column 3
None
Row 2, Column 0
Occur, no concerns
Row 2, Column 1
Occur, want to improve
Row 2, Column 2
Describe
Row 2, Column 3
None
Row 3, Column 0
Occur, no concerns
Row 3, Column 1
Occur, want to improve
Row 3, Column 2
Describe
Row 3, Column 3
None
Row 4, Column 0
Occur, no concerns
Row 4, Column 1
Occur, want to improve
Row 4, Column 2
Describe
Row 4, Column 3
None
Row 5, Column 0
Occur, no concerns
Row 5, Column 1
Occur, want to improve
Row 5, Column 2
Describe
Row 5, Column 3
None
Row 6, Column 0
Occur, no concerns
Row 6, Column 1
Occur, want to improve
Row 6, Column 2
Describe
Row 6, Column 3
None
Row 7, Column 0
Occur, no concerns
Row 7, Column 1
Occur, want to improve
Row 7, Column 2
Describe
Row 7, Column 3
None
Row 8, Column 0
Occur, no concerns
Row 8, Column 1
Occur, want to improve
Row 8, Column 2
Describe
Row 8, Column 3
None
Row 9, Column 0
Occur, no concerns
Row 9, Column 1
Occur, want to improve
Row 9, Column 2
Describe
Row 9, Column 3
1 of 10
83
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