Weber Animal Behavior
Feline Behavior History Form
How did you hear about Weber Animal Behavior?
Guardian Information
Legal Owner Full Name:
First Name
Last Name
Email:
example@example.com
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Other guardian/caregiver name:
Other guardian/caregiver email:
example@example.com
Other guardian/caregiver phone:
Please enter a valid phone number.
Format: (000) 000-0000.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
House color and parking instructions (for home visits):
Animal Information
Cat's name:
Breed or mix:
Current age:
Sex and neuter status:
Male
Neutered male
Female
Spayed female
Is your cat declawed?
No
Yes, front paws only
Yes, all four paws
Is this your first cat?
Yes
No
No, but it has been a while (e.g., I had cats while growing up)
Where did you get the cat?
Rescue/Shelter
Breeder
Friend/relative
Stray
Other
How long has the cat lived with you?
What do you know about the cat's previous history?
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Family Makeup
Describe all humans in the cat's life:
Rows
Name
Age
Pronouns
Relationship (live together, visit frequently, recently gone/passed, get along, conflict, etc.)
1
2
3
4
Describe all animals in the cat's life:
Rows
Name
Age
Species (dog, cat, bird, etc.)
Relationship (live together, visit frequently, recently gone/passed, get along, conflict, etc.)
1
2
3
4
Are any other pets directly involved in the concerning behaviors?
No
Yes, 1 other pet
Yes, 2 or more other pets
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Veterinary & Health Information
Do you have pet insurance?
Yes
No
Name of your vet clinic and/or preferred veterinarian:
Date of last vet visit:
 -
Month
 -
Day
Year
Date
Describe any recommendations given by the veterinarian for your concerns:
List any current, recent, and past medical issues or injuries:
List any medications or supplements:
List any food or environmental sensitivities or allergies:
What brand/kind of food do you feed?
Describe your feeding routine:
Dry, available all day
Dry, fed on a schedule
Canned, available all day
Canned, fed on a schedule
Raw, fed on a schedule
Dry all day and canned on schedule
Other
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Behavior History
Describe the problem behavior(s) and indicate which one concerns you the most:
Regarding the behavior that concerns you the most, when did you first notice the behavior?
Is the behavior predictable or are there any specific triggers?
How often does the behavior occur?
Several times per day
Once per day
Several times per week
Once per week
Several times per month
Randomly
Only in specific situations
Only once or twice
Other
Have you had this problem with any previous or other pets?
Yes
No
I don't know
Have you sought advice for this problem before?
What specifically have you done to try and prevent and/or resolve the behavior?
Are you prepared for it to take time to resolve the problem behavior, up to several months or longer?
Yes
No
Undecided/uncertain
Have you considered other options, if the problem behavior cannot be resolved to your satisfaction?
I will do whatever it takes
I have considered (or am considering) giving up the cat
Undecided/uncertain
Have there been any changes to the home recently?
No
New furniture
Addition of a baby
Remodel or worker in home
New job
Change in routine
New pet
Change in food or litter
Other
How often do you play with your cat?
Multiple times per day
Daily
Sometimes
Rarely
My cat doesn't play
Describe playtime with your cat:
Is your cat indoor or outdoor?
Indoor only
Walks on a leash
Indoor/outdoor with supervision
Indoor/outdoor unsupervised
Outdoor only
Other
How do you typically reward good/wanted behaviors?
Petting
Verbal praise
Treats/food
Toys/play
I don't know
Other
How do you typically punish bad/unwanted behaviors?
Physically (spanking, nose tap, etc.)
Verbally (scold, yell, etc.)
Noise, clapping, or squirt bottle
Redirection
I don't know
Other
Number of hours per day you typically spend at home:
Describe your typical day:
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Litter Box Habits
Is your cat urinating or defecating outside of the litter box?
Yes
No
What elimination is happening outside the litter box?
Some urine outside the box
All urine outside the box
Some feces outside the box
All feces outside the box
Some urine and feces outside the box
All urine and feces outside the box
Other
What material is your cat is soiling on?
Tile or linoleum
Hardwood or laminate
Carpet or rugs
Laundry, towels, clothing, shoes, or other personal belongings
Counter, table, or high surfaces
Cat's furniture or bedding
Other animal's furniture or bedding
Human furniture or bedding
Other
Where is the cat eliminating?
Floor, within 1 foot of litter box
Floor, more than 1 foot from litter box
On or near windows or doors
Where family spends time
Hidden area (under bed, in closet)
In front of human
Other
Does the cat experience any discomfort when it eliminates (straining, vocalizing)?
Yes
No
How many litter boxes do you have?
Describe the litter box locations:
Litter box type(s):
Covered
Open
Auto-clean
Lined
Top entry
Other
Litter substrate type(s):
Clumping
Non-clumping
Pelleted
Scented
Other
How often is the litter box scooped?
Multiple times per day
Daily
Several times per week
Weekly
Less than weekly
How often is the litter box emptied, fully cleaned, and the litter replaced?
Weekly
Every two weeks
Monthly
Rarely
Never
Describe elimination:
Large puddles on a horizontal surface
Small puddles on a horizontal surface
On a vertical surface
Feces soft (like soft serve)
Feces firm (like a tootsie roll)
Feces hard/dry (like an old tootsie roll)
Destructive Behavior
Is your cat scratching your belongings?
Yes, and I want it to stop
Yes, but it doesn't bother me
No
What surfaces are being scratched?
Couch, chair, human bed, or other furniture
Carpet or throw rugs
Woodwork, posts, or rails
Walls or wallpaper
Window screens
Fabric
Leather
Wood
Other
How many scratching posts do you have?
0
1
2-3
4+
Describe your scratching posts:
Sisal rope
Cardboard
Carpet
Lies flat or horizontally
Hangs or stands upright or vertically
Sturdy and doesn't move when cat scratches at it
Wobbles, moves, or swings during scratching
Other
How often does the cat use the scratching post?
Regularly or often
Sometimes
Rarely or never
How often are the cat's nails trimmed?
Weekly
Monthly
Occasionally
Never
Who trims the cat's nails?
Veterinarian
Groomer
Guardian/caregiver
Other
Is restraint or sedation needed?
No
Yes
If restraint or sedation is needed, please describe:
Aggressive Behavior
Is your cat displaying aggression (hiss, growl, swat)?
Yes
No
Describe the aggression:
Hiss
Growl
Swat, no contact
Swat, no damage
Swat, bleeding
Swat, medical care needed
Bite, no contact
Bite, no damage
Bite, bleeding
Bite, medical care needed
Multiple bites in single event
Other
Who has the aggression been directed toward?
Adult
Child
Cat
Dog
Member of the househood
Visitor (familiar to the cat, but not living in household)
Stranger
Other
When is the aggression occurring?
During petting
During handling or restraint
During play
When walking past
When getting too close
Around mealtime
Randomly
In the home
Outdoors
At the vet or groomer
Other
Describe the circumstances of the most severe incident:
Please provide any additional information you feel is relevant:
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Agreement, Waiver, and Release
Please review the Terms and Conditions as well as the Policies and Expectations below by clicking on the links. Check both boxes to accept and proceed.
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