Feline Behaviour Consultation Questionnaire

Feline Behaviour Consultation Questionnaire
Name *

First Name Last Name
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / 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 *

Phone E-Mail Text
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
Name Practice
Address

Street Address

Street Address Line 2

City State / Province

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

Cats Information
Name
Date of Birth

Month Day Year
Date
Breed
Colour
Weight
kilograms pounds
Age Obtained
Years Months Weeks
Sex

Male Female
Spayed/Neutered

Yes No
Age spayed or neutered?
Years Months Weeks
Any behavioural changes after spay/neuter?

Yes No I don't know
Please describe
Is your cat declawed?

Yes No
Age declawed
Years Months Weeks
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 family Companionship for other pet Rodent Control Breeding Showing Other
Please describe
Describe your cats personality (check all that apply)

Friendly Bold Over-active Playful Demanding attention Independent Fearful/Nervous Aggressive Noisy/Vocal Excitable Depressed Other
Please describe

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?

Yes No
Please explain, including with whom your cat is having the issue
Do you have other pets in the home?

Yes No
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?

Yes No
Please describe, in as much detail as possible
Does your cat have a favored climbing/perching/play center?

Yes No
Please describe using as much detail as possible
Does your cat climb/perch/play in areas that you find undesirable?

Yes No
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?

Yes No
Please describe

Diet and Nutrition
What type of food do you feed? (Please be as specific as possible)
Is your cat

Meal fed Free 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

Voracious Good Average Picky Poor Variable
Do you give your cat treats

Yes No
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

Voracious Good Average Picky Poor Variable
Is your cat taking any supplements?

Yes No
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?

Yes No I 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?

Yes No

Daily Routine
Describe you and your cats daily schedule.
Does your cat spend time outside?

Yes No
When your pet is outside is it (select all that apply)

Confined to the yard On a harness Free to roam Not 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?

Yes No I don't know
Please describe
Have you used a crate for housing or travel?

Yes No
What is your cats reaction to the crate?

Play and Activities
Do you play with your cat?

Yes No
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?

Yes No
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?

Yes No
Please describe
What are your cats favorite toy's or activities?
Does your cat engage in over-exuberant or unacceptable play?

Yes No
Please describe
Does your cat chew on or swallow objects that are inappropriate or undesirable?

Yes No
Please describe

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

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?

Yes No
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

Training
What type of training have you done with your cat (Please select all that apply)

None Structured Kitten Class Private Trainer Self taught Other
Please describe
Please describe your cats learning ability
Does your cat respond to any cues?

Yes No Sometimes Rarely
Please select all that apply

Sit Down Off Come Stay Go to place (bed/kennel/room) Targeting High five Leave it Bring it
Does your cat respond to any other cues or perform tricks?

Yes No
Please describe
Does your cat respond differently to cues from different family members?

Yes No
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?

Very Most times Occasional Unsuccessful Other
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?

Yes No

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?

Yes No
Please describe
Has punishment ever resulted in aggression?

Yes No
Please describe
Does your cat respond differently to punishment from different family members?

Yes No
Please describe

Grooming and Skin Disorders
Does your cat's self grooming appear to be

Normal Excessive Decreased
Does your cat lick or groom (please select all that apply)

Self Other cats in home Other pets (that are not cats) in home People in Home Household objects Other
Please describe
Does your cat knead?

Yes No
When and with whom does your cat knead?
Do you feel that your cats kneading is excessive?

Yes No I don't know
Does your cat have problems with overgrooming, rippling skin, excessive scratching or hair loss?

Yes No
Is the problem

Improving Staying the same Getting worse
When did the problem first begin (age, time of year, etc.)
Do any of the pets in the household go outside?

Yes No
Which pets in the home go outside?
Were there changes in the household before the problem began?

Yes No
Please describe
Were there changes in the cat's behaviour or health prior to the problem?

Yes No I don't know
Please describe
Has the frequency/severity/pattern or type of hair loss changed since the problem first arose?

Yes No I don't know
Please describe
Is there a particular event that is most likely to aggravate the problem?

Yes No I don't know
Please describe
Is there a particular time of month or year that the problem gets worse?

Yes No I don't know
Please explain
Is there a particular time of month or year that the problem improves?

Yes No I don't know
Please explain
Is the behaviour more likely to occur when you are (select all that apply)

At home in the room At home out of the room Away from home
Do any other pets at home have skin problems?

Yes No
Please describe
Do any other family members have skin issues?

Yes No
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?

Scratching Behaviours
Does your cat scratch in areas that are undesirable?

Yes No
Please list undesirable locations
How often and when does your cat scratch these locations?
Are there specific events that precede scratching?

Yes No I don't know
Please describe
Do you see your cat scratching?

Yes No
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.

Elimination and Litterbox Care
Do you have concerns with your cat urinating or defecating outside of the litterbox/designated bathroom area?

Yes No I'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 sifting Easy sift Top entry
Has your cat every been fully litter trained?

Yes No I don't know
At what age did the elimination problem begin?
Is the problem

Getting worse Staying the same Improving
Is the soiling

Urine Stools Both
% Urine Soiling
% Stool Soiling
At the time the problem began, describe your cats stool (select all that apply)

Normal Constipation Less Frequent More Frequent Soft Diarrhea Blood/Mucous Straining/discomfort to pass stool Vocalization when passing stool
At the time of this consultation request, describe your cats stool (select all that apply)

Normal Constipation Less Frequent More Frequent Soft Diarrhea Blood/Mucous Straining/discomfort to pass stool Vocalization when passing stool
At the time the problem began, describe your cats urine (select all that apply)

Normal Less Frequent More Frequent More Volume Less Volume Straining/discomfort when urinating Vocalization when urinating Blood
At the time of this consultation request, describe your cats urine (select all that apply)

Normal Less Frequent More Frequent More Volume Less Volume Straining/discomfort when urinating Vocalization when urinating Blood
Is the urine soiling

Only on horizontal surfaces (floors) Only on vertical services (upright) Mostly upright and some horizontal Mostly horizontal and some upright Both upright and horizontal
Is there a particular surface or texture on which your cat prefers to soil?

Yes No I don't know
Please describe
Are there any surface types where your cat never soils?

Yes No I don't know
Please describe
Is there a room or location where your cat prefers to soil?

Yes No I don't know
Please describe
Is there a room or location where your cat never soils?

Yes No I 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?

Yes No I'm not sure
Please describe
Were there any changes to the litter when the problem began?

Yes No I'm not sure
Please describe
Have you seen your cat soiling?

Yes No
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.

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:

Mild Moderate High Excessive
How long after exposure to these events does it take your cat to settle back to normal?
Are there any problems with travelling?

Yes No
Please describe
How do you travel with your cat?

Carried by family member On seat, not secured On seat, secured In kennel Other
Please explain

Aggression Screening
Does your cat display aggression?

Yes No
What is the severity of your cats aggression?

Mild Moderate Severe
Please indicate to which of the following your cat has shown aggression (select all that apply)

Family members Visitors Familiar cats in home Unfamiliar cats in home Outdoor cats Dogs in home Other animals (please specify) Veterinary Visits Groomer Other (please specify)
Please specify
Is the aggression serious enough that you will be unable to keep your cat if it is not improved?

Yes No I don't know
Have you considered euthanasia of your cat due to aggression problems?

Yes No
Describe your cat's demeanor at the time of aggression?

Bold Playful Fearful Other
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 bite Bites, but not break skin Bite with minor injury Bite with serious injury Scratch, but nor break skin Scratch with minor injury Scratch with serious injury Other
Please describe
How often does the problem occur

Rarely Monthly Weekly A couple times a week Daily Multiple times a day Other
Please describe
Is the problem

Getting better Staying the same Getting 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?

Yes No
Please describe
Has any treatment to date made the problem worse?

Yes No
Please describe
Please make any additional comments regarding your cats aggression here:

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?

Yes No
Please list, including name of medication dosage, and how long your cat has been taking
Should be Empty:

Feline Behaviour Consultation Questionnaire

Regular DVM

Cats Information

The Home Environment

Diet and Nutrition

Daily Routine

Play and Activities

Handling

Training

Grooming and Skin Disorders

Scratching Behaviours

Elimination and Litterbox Care

Fear and Reactivity Screening

Aggression Screening

Miscellaneous