• Feline Behaviour Consultation Questionnaire

• Name*
  First NameLast Name
• Email*
  example@example.com
• Address*
  Street Address

  Street Address Line 2

  CityState / Province

  Postal / Zip Code
• Primary Phone Number*
  Please enter a valid phone number.
• Secondary Phone Number
  Please enter a valid phone number.
• Preferred Form of Communication*
  PhoneE-MailText
• Preferred Time of Appointment*
  Morning (Between 9am-11am)Afternoon (Between 1pm-4pm)Evening (Between 5pm-7pm)
• How did you hear about our service?

• Regular DVM

• NamePractice
• Address
  Street Address

  Street Address Line 2

  CityState / Province

  Postal / Zip Code
• Phone Number
  Please enter a valid phone number.
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• Cats Information

• Name
• Date of Birth
   -Month -DayYear

  Date
• Breed
• Colour
• Weight
• kilogramspounds
• Age Obtained
• YearsMonthsWeeks
• Sex
  MaleFemale
• Spayed/Neutered
  YesNo
• Age spayed or neutered?
• YearsMonthsWeeks
• Any behavioural changes after spay/neuter?
  YesNoI don't know
• Please describe
• Is your cat declawed?
  YesNo
• Age declawed
• YearsMonthsWeeks
• Where did you obtain this cat?
• Describe previous homes, including litter size, how raised, age weaned, other pets or children in the previous home.
  If known
• Describe how much interaction your cat has had with people before coming to live with you. Please include sex, and age of any children.
  If known
• Describe how much interaction your cat has had with other animals before coming to live with you. Please include species and age of other animals.
  If known
• Please describe behaviour of parents and littermates
  If known
• For what reason did you obtain this cat (please check all that apply)
  Companionship for familyCompanionship for other petRodent ControlBreedingShowingOther
• Please describe
• Describe your cats personality (check all that apply)
  FriendlyBoldOver-activePlayfulDemanding attentionIndependentFearful/NervousAggressiveNoisy/VocalExcitableDepressedOther
• Please describe
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• The Home Environment

• List each family member at home (including sex and age of children)
• Does your cat have any issues getting along with family members?
  YesNo
• Please explain, including with whom your cat is having the issue
• Do you have other pets in the home?
  YesNo
• Please list all other pets in the home, including species, age, breed, sex and if spayed of neutered
• Is there any conflict between the pets in your home?
  YesNo
• Please describe, in as much detail as possible
• Does your cat have a favored climbing/perching/play center?
  YesNo
• Please describe using as much detail as possible
• Does your cat climb/perch/play in areas that you find undesirable?
  YesNo
• Please describe with as much detail as possible
• Where is you cats favored sleeping spot/resting area during the day?
• Where is your cats favored sleeping spot/rest area during the night?
• Does your cat have a scratching area/preferred scratching location?
  YesNo
• Please describe
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• Diet and Nutrition

• What type of food do you feed? (Please be as specific as possible)
• Is your cat
  Meal fedFree choice fed (available all the time)A combination of both meal and free choice feeding
• At what time of day is your cat fed?
• How much do you feed your cat at each feeding?
• Describe your cats appetite
  VoraciousGoodAveragePickyPoorVariable
• Do you give your cat treats
  YesNo
• What type of treats do you give to your cat?
• Please describe how often and at what time of day you give treats
• Describe your cats appetite for treats
  VoraciousGoodAveragePickyPoorVariable
• Is your cat taking any supplements?
  YesNo
• Please list all supplements that your cat is taking, or has taken in the past six months. Include amount given, frequency and how long your cat has been taking the supplement, and if applicable, when or why you stopped.
• Does your cat hunt?
  YesNoI don't know
• At what time of day does your cat hunt?
• How often does your cat hunt?
• What is your cats favored prey?
• Does your cat eat the prey?
  YesNo
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• Daily Routine

• Describe you and your cats daily schedule.
• Does your cat spend time outside?
  YesNo
• When your pet is outside is it (select all that apply)
  Confined to the yardOn a harnessFree to roamNot confined but does not leave yard
• How often does your cat spend time outside?
• How long does your cat stay outdoors?
• Does your cat see, hear or come in contact with outdoor cats?
  YesNoI don't know
• Please describe
• Have you used a crate for housing or travel?
  YesNo
• What is your cats reaction to the crate?
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• Play and Activities

• Do you play with your cat?
  YesNo
• What time(s) of day do you play with your cat?
• What type of play do you do with your cat?
• Who plays with your cat?
• Does your cat engage in play on it's own?
  YesNo
• What time of day does your cat engage in play on it's own?
• Describe your cats favorite games to play on it's own
• Does your cat have an activity center?
  YesNo
• Please describe
• What are your cats favorite toy's or activities?
• Does your cat engage in over-exuberant or unacceptable play?
  YesNo
• Please describe
• Does your cat chew on or swallow objects that are inappropriate or undesirable?
  YesNo
• Please describe
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• Please indicate your cat's level of interest in the following activities

  	High	Low	None	Have not tried	How often?	Additional comments
  Chase toys with family member
  Self play- batting toys
  Self play- run/chase
  Food filled toys
  Exploring
  Fetch/Chase
  Chewing cat grass
  Laser toys
  Catnip
  Climbing
  Perching
  Scratch post
  Going outdoors

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• Handling

• Please rate how your cat responds to the following handling by family members

  	Unknown	Enjoys	Resists	Willing	Reluctant	Threatens/ Aggressive	Cannot attempt	Additional Comments
  Petting/stroking head/neck
  Petting/stroking back/tail
  Rubbing belly
  Brushing
  Hugging/kissing
  Restrained on lap
  Nail trimming
  Ear cleaning/medicating
  Eye cleaning/medicating
  Bathing
  Lifted/Carried
  Giving liquid medication
  Giving pill form medication

• Are there differences in the way the cat responds to handling by different family members?
  YesNo
• Please describe
• Please rate how your cat responds to the following handling by strangers

  	Unknown	Enjoys	Resists	Willing	Reluctant	Threatens/ Aggressive	Cannot attempt	Additional Comments
  Petting/stroking head/neck
  Petting/stroking back/tail
  Rubbing belly
  Brushing
  Hugging/kissing
  Restrained on lap
  Nail trimming
  Ear cleaning/medicating
  Eye cleaning/medicating
  Bathing
  Lifted/Carried
  Giving liquid medication
  Giving pill form medication

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• Training

• What type of training have you done with your cat (Please select all that apply)
  NoneStructured Kitten ClassPrivate TrainerSelf taughtOther
• Please describe
• Please describe your cats learning ability
• Does your cat respond to any cues?
  YesNoSometimesRarely
• Please select all that apply
  SitDownOffComeStayGo to place (bed/kennel/room)TargetingHigh fiveLeave itBring it
• Does your cat respond to any other cues or perform tricks?
  YesNo
• Please describe
• Does your cat respond differently to cues from different family members?
  YesNo
• Who is your cat most likely to respond to?
• Who is your cat least likely to respond to?
• If you wanted to get your cats attention or get your cat to come, what would work best? (eg. Shaking a box of treats, using a cue, whistle, crinkling paper, etc)
• How successful would this be?
  VeryMost timesOccasionalUnsuccessfulOther
• Please describe
• List your cats top three food rewards
  .
• List your cats top three non-food rewards (eg; toys, affection etc)
  .
• Please rate your cats response to the following

  	Have not tried	Improved Behaviour	Worsened Behaviour	No Effect on Behaviour	Additional Comments
  Positive Reinforcement
  Lure/Reward Training
  Food/Treat rewards
  Toy/Play rewards
  Affection reward
  Clicker training
  Assertive/confrontational interactions
  Body Harness
  Collar

• Have you ever used punishment or corrections with your cat?
  YesNo
• Please rate your cats response to the following punishment or corrections

  	Have not tried	Improved Behaviour	Worsened Behaviour	No Effect on Behaviour	Additional Comments
  Verbal reprimand
  Physical punish/hit/swat
  Scruff/neck grasp
  Physical lift/pin
  Shake can/noise
  Ultrasonic Noise
  Water sprayer
  Air or citronella spray
  Booby trap
  Repellent
  Time out/confinement

• Have you used any other punishment not listed above?
  YesNo
• Please describe
• Has punishment ever resulted in aggression?
  YesNo
• Please describe
• Does your cat respond differently to punishment from different family members?
  YesNo
• Please describe
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• Grooming and Skin Disorders

• Does your cat's self grooming appear to be
  NormalExcessiveDecreased
• Does your cat lick or groom (please select all that apply)
  SelfOther cats in homeOther pets (that are not cats) in homePeople in HomeHousehold objectsOther
• Please describe
• Does your cat knead?
  YesNo
• When and with whom does your cat knead?
• Do you feel that your cats kneading is excessive?
  YesNoI don't know
• Does your cat have problems with overgrooming, rippling skin, excessive scratching or hair loss?
  YesNo
• Is the problem
  ImprovingStaying the sameGetting worse
• When did the problem first begin (age, time of year, etc.)
• Do any of the pets in the household go outside?
  YesNo
• Which pets in the home go outside?
• Were there changes in the household before the problem began?
  YesNo
• Please describe
• Were there changes in the cat's behaviour or health prior to the problem?
  YesNoI don't know
• Please describe
• Has the frequency/severity/pattern or type of hair loss changed since the problem first arose?
  YesNoI don't know
• Please describe
• Is there a particular event that is most likely to aggravate the problem?
  YesNoI don't know
• Please describe
• Is there a particular time of month or year that the problem gets worse?
  YesNoI don't know
• Please explain
• Is there a particular time of month or year that the problem improves?
  YesNoI don't know
• Please explain
• Is the behaviour more likely to occur when you are (select all that apply)
  At home in the roomAt home out of the roomAway from home
• Do any other pets at home have skin problems?
  YesNo
• Please describe
• Do any other family members have skin issues?
  YesNo
• Please describe
• What techniques or medications have you tried that have made the problem BETTER?
• What techniques or medications have you tried that have made the problem WORSE?
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• Scratching Behaviours

• Does your cat scratch in areas that are undesirable?
  YesNo
• Please list undesirable locations
• How often and when does your cat scratch these locations?
• Are there specific events that precede scratching?
  YesNoI don't know
• Please describe
• Do you see your cat scratching?
  YesNo
• Please describe in detail your reaction to seeing your cat scratching and your cats reaction to you
• Please describe in detail your reaction when you find an area that your cat has been scratching without your knowledge and your cats reaction to you.
• What have you tried so far to treat the scratching, and has it been effective? Please be as specific as possible.
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• Elimination and Litterbox Care

• Do you have concerns with your cat urinating or defecating outside of the litterbox/designated bathroom area?
  YesNoI'm not sure
• Please rate how often the following occurs

  	Many times a day	Once daily	Weekly	Every two weeks	Monthly	Never	Additional Comments
  Cat urinates in litter box
  Cat urinates outside of litter box
  Cat sprays/ Urine Marks
  Cat defecates in litter box
  Cat defecates outside of litter box
  Cat eliminates outdoors
  Litterbox is scooped out
  Litter is replaced with new litter
  Litter box is cleaned and washed

• Where is your litter box(s) located?
• What type of litter do you use?
• What type of litter does your cat prefer?
• How many litter boxes do you have?
• What type of litter box do you have (select all that apply)
  Covered shallow (less than 4 inches deep)Covered deep (greater than 4 inches deep)Uncovered shallow (less than 4 inches deep)Uncovered deep (greater than 4 inches deep)Automatic siftingEasy siftTop entry
• Has your cat every been fully litter trained?
  YesNoI don't know
• At what age did the elimination problem begin?
• Is the problem
  Getting worseStaying the sameImproving
• Is the soiling
  UrineStoolsBoth
• % Urine Soiling
• % Stool Soiling
• At the time the problem began, describe your cats stool (select all that apply)
  NormalConstipationLess FrequentMore FrequentSoftDiarrheaBlood/MucousStraining/discomfort to pass stoolVocalization when passing stool
• At the time of this consultation request, describe your cats stool (select all that apply)
  NormalConstipationLess FrequentMore FrequentSoftDiarrheaBlood/MucousStraining/discomfort to pass stoolVocalization when passing stool
• At the time the problem began, describe your cats urine (select all that apply)
  NormalLess FrequentMore FrequentMore VolumeLess VolumeStraining/discomfort when urinatingVocalization when urinatingBlood
• At the time of this consultation request, describe your cats urine (select all that apply)
  NormalLess FrequentMore FrequentMore VolumeLess VolumeStraining/discomfort when urinatingVocalization when urinatingBlood
• Is the urine soiling
  Only on horizontal surfaces (floors)Only on vertical services (upright)Mostly upright and some horizontalMostly horizontal and some uprightBoth upright and horizontal
• Is there a particular surface or texture on which your cat prefers to soil?
  YesNoI don't know
• Please describe
• Are there any surface types where your cat never soils?
  YesNoI don't know
• Please describe
• Is there a room or location where your cat prefers to soil?
  YesNoI don't know
• Please describe
• Is there a room or location where your cat never soils?
  YesNoI don't know
• Please describe
• What time of day is the problem most likely to occur?
• What patterns have you noticed tend to occur when the problem happens?
• Were there any changes to the household when the problem began?
  YesNoI'm not sure
• Please describe
• Were there any changes to the litter when the problem began?
  YesNoI'm not sure
• Please describe
• Have you seen your cat soiling?
  YesNo
• What was your response when you saw your cat soiling, and your cats response to you?
• List any techniques that you have tried that have IMPROVED the problem
• List any techniques that you have tried that have made the problem WORSE
• List any pharmaceuticals, nutraceuticals, or pheromones that you have tried and your cats response to each.
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• Fear and Reactivity Screening

• Please indicate how your cat reacts to each of the following

  	Calm	Playful/Friendly	Ambivalent	Fearful	Confused	Aggressive	Unknown	Additional Comments
  Familiar cats in home
  Unfamiliar cats in home
  Familiar cats outside home
  Unfamiliar cats outside home
  Unfamiliar visitors to home
  Familiar visitors to home
  Veterinary Visits
  Vacuum cleaner
  Car rides
  Thunderstorms
  Fire Works
  Other loud noises (eg shouting)
  Familiar dogs in home
  Familiar dogs outside of home
  Unfamiliar dogs in home
  Unfamiliar dogs outside of home
  Familiar children in home
  Unfamiliar children in home
  Familiar children outside the home
  Unfamiliar children outside the home

• Describe your cats level of arousal in these situations:
  MildModerateHighExcessive
• How long after exposure to these events does it take your cat to settle back to normal?
• Are there any problems with travelling?
  YesNo
• Please describe
• How do you travel with your cat?
  Carried by family memberOn seat, not securedOn seat, securedIn kennelOther
• Please explain
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• Aggression Screening

• Does your cat display aggression?
  YesNo
• What is the severity of your cats aggression?
  MildModerateSevere
• Please indicate to which of the following your cat has shown aggression (select all that apply)
  Family membersVisitorsFamiliar cats in homeUnfamiliar cats in homeOutdoor catsDogs in homeOther animals (please specify)Veterinary VisitsGroomerOther (please specify)
• Please specify
• Is the aggression serious enough that you will be unable to keep your cat if it is not improved?
  YesNoI don't know
• Have you considered euthanasia of your cat due to aggression problems?
  YesNo
• Describe your cat's demeanor at the time of aggression?
  BoldPlayfulFearfulOther
• Please describe
• Describe your cat's appearance at the time of aggression (body posture, face, ears, tail, hair on back)
• Describe the aggression (select all that apply)
  Threats, no biteBites, but not break skinBite with minor injuryBite with serious injuryScratch, but nor break skinScratch with minor injuryScratch with serious injuryOther
• Please describe
• How often does the problem occur
  RarelyMonthlyWeeklyA couple times a weekDailyMultiple times a dayOther
• Please describe
• Is the problem
  Getting betterStaying the sameGetting worse
• Please describe, with as much detail as possible the most recent incident of aggression. Include what happened immediately prior to the event, the cat's body posture, your reaction, and your cats reaction to you.
• Has any treatment to date made the problem better?
  YesNo
• Please describe
• Has any treatment to date made the problem worse?
  YesNo
• Please describe
• Please make any additional comments regarding your cats aggression here:
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• Miscellaneous

• Please select other behaviours that your cat dislays

  	None	Occurs, no concern	Occurs, would like to improve	Reason for visit today	Additional comments
  Jumps on counter
  On furniture where not allowed
  In rooms where not permitted
  Nips/grabs/play bites
  Altered sleep/night waking
  Hyper active/ Over exuberant
  Hiding/Avoidance
  Not social/ avoids affection
  Climbing
  Vocalization
  Licking
  Tail chasing/ Attack
  Sucking
  Light chasing
  Snaps at air
  Hyperesthesia (rippling skin)
  Roaming/Running away
  Mounting

• Is your cat currently on any medications?
  YesNo
• Please list, including name of medication dosage, and how long your cat has been taking
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