Feline Behaviour Questionnaire

Feline Behaviour Questionnaire

Completing this form is part of your assessment
Thank you for being here to complete your form, this is the first step in making changes.

Please navigate through each section in order and only complete this form if you intend to proceed with a booking.

Current availability for new cases to start (subject to change at any time is as follows):

Feb: availability for 4 new cases to start on either: 24th, 28th

Mar: availability for 4 new cases to start on either: 3rd, 10th, 17th, 23rd, 31st

Apr: CLOSED until Tue 18th. Availability for 4 new cases to start on either: 18th, 21st, 25th, 28th

Appointment slots: Tue & Fri until midday. Behaviour assessments are 12pm in-person or 12.30pm via zoom - Zoom only available on Fridays.

This will change quickly as there is usually at least a 1-month waiting list.

BOOKING POINT: This can be accessed once you have completed this form.

Please ensure you allow ample time to complete this form. This is an extensive document to gather as much data as possible to help you succeed.

This form is best to be completed on a computer or tablet.

Please remember to save your form to ensure you do not lose your answers. You can also then return to complete it. The save button is at points throughout and at the bottom of the form.

Obtaining the following information prior to consultation allows more time to be dedicated to assessment and treatment. Please ensure this document, as well as the veterinary referral form, are completed and signed so your assessment can proceed.

Please fill in each question as accurately and honestly as possible, there are no right or wrong answers. The more information you provide here, the less time is needed to clarify answers on assessment.

Once your form is submitted you will be signposted to book your behaviour programme. This form will not be read until you have secured your programme and behaviour assessment appointment.

If you have any issues: this usually relates to the browser you are using. If you have difficulties please WhatsApp on 07841040171 during business hours for a work around.
I understand and will book my programme
I understand and have initiated this form
In-Person: Tue or Fri 12pm (occasionally 9.30am) (subject to change/availability)Online: Fri at 12.30pm
PRIVACY POLICY
Your data is collected, stored and used in line with the General Data Protection Regulation (GDPR).

The personal data you share with us allows us to visit you for home visits, communicate educational resources, prepare for group or private sessions and contact you when we need to regarding the service you have booked (especially in the event of emergency). It also allows us to ensure you are recieve the correct service.

A full copy of our privacy policy can be found here.

Consent
By consenting to this privacy policy notice you are giving us permission to process your personal data specifically for the identified purposes. Consent is required for Katey Aldred to process your personal data, but it must be explicitly given. Where we are asking you for sensitive personal data we will always tell you why and how the information will be used.

You may withdraw consent at any time by contacting us to inform us, all data held will immediately be erased.
I give consent for my details to be collected and stored and wish to proceed with my behaviour programmeI do not consent for my details to be collected and stored wish to terminate my behaviour programme (please just close this window if you select this option and contact us to discuss booking).

Section One: Owner Information
TECH CHECK:

- Complete with a tablet or computer

- Ensure you have a stable internet connection

- Ensure you enter the correct email address. Each time you SAVE you will be provided with a pop-up window with a link (copy and keep this safe) and an email. If the email does not arrive please check your spam folder and allow up to 30-minutes for this to push through.

Complete this section, click SAVE then head to your emails to ensure you receive the link to complete the form.

In case of an issue send a text or WhatsApp to Katey on 07841040171 in the first instance.

Issues are usually related to the browser and device you are using please do not use a phone.
Your Name*

First NameLast Name
Your E-mail*
Mobile Number*

Area CodePhone Number
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Postcode*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Family living in the home: name/age/relationship*
Extended family with regular contact: name/age/relationship*
Other pets: species/name/age & type of relationship*
Please write N/A if no other pets

Cat ownership questions

Rows	Yes	No
Have you owned a cat before?
Have you owned this breed of cat before?
Have you owned other pets previously?
Has your cat been used for breeding?

Family Routine: has there been any changes to the household recently (change of work hours, new baby, moving, new visitors, diet change etc)?*
Please write N/A if not applicable
Home Environment: What type of property do you live in? What areas does your cat have access to?*
Please write N/A if no other pets
QuietLivelyVery busyChaotic
Do you or any family members caring for your cat have any medical, or learning issues you feel the assessor should be aware of (deafness, anxiety, learning difficulties for example)?*
Please write N/A if no other pets

Section Two: Cat's Information
Name & Breed*

NameBreed
Please upload a favourite photo of your cat

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D.O.B & Age*

D.O.BAge
Age obtained*
Obtained from?*
ie breeder, rescue
Decision for choosing this breed or individual?*
Please provide details of your cat's early life to the best of your knowledge: litter size, age of weaning, location raised (inside/outside), orphan, stray, hand reared or any other pertinant points.*
In the first year of life, how much interaction was had with people (frequency, numbers of people)*
What method of litter training was used and how did you react to any mistakes during litter training?*
Did your cat destroy anything whilst a kitten?*
Please write NA if no info to provide
Female EntireFemale NeuteredMale EntireMale Neutered
If neutered, reason for neutering:*
Write N/A if entire
YesNo
Home many previous homes? (if answered yes above)*
Write N/A if not had previous owners
Rehome reason*
Write N/A if not had previous owners
Briefly describe your cat’s personality when not experiencing the issue (confident, timid etc) PLEASE DO NOT WRITE ABOUT THE PROBLEM BEHAVIOUR HERE THERE IS ROOM FOR THIS IN SECTION SEVEN.*
Describe interactions with pets:*
N/A if no other pets
Multi-cat households: Do you see them all in the same room? What locations do you see each cat in the most (state specifically).*
Please write N/A if no other pets
How does your cat behave with visitors (hides, interacts with them, acts interested, quick to approach etc):*
Is the behaviour different between visitors and family members? If yes please describe:*
Describe interactions with family:*
Please describe how your cat reacts to the following people stating 1) at home and 2) outside*
Is your cat restricted from any areas? If yes, how and your cat’s reaction:*
Cat’s favourite sleeping location:*
Day time sleeping place:*
Night time sleeping place:*
Does you cat seek out high places to rest? Where:*
Where does your cat rest during the day?*

Daily Activities - please select the best descriptor for each activity*

Rows	Not every day	Up to 30 minutes	30-60 minutes	1-2 hours	Over 2 hours	Only at weekends	Never
Time outdoors
Training
Grooming
Affection
Day time activity
Night time activity
Play alone / with toys
Play with another pet
Play with the owner

If you wrote 'other' please include what here:
What type of outside access does your cat have (yard/garden etc)? How is this accessed (cat flap - if so what type)?*
Does your cat roam? What area is available for this and how far does your cat roam on average? (only in garden, maybe to a few neighbours, further ranging etc)*
Does your cat stay away from home for several days, if so do you have any further details?*
Does your cat defend their territory against other cats? If yes please describe your cats reaction.*

How often do you see other cats in your garden?*

Rows	Daily	Once per week	Several times per week	Rarely	NA
Frequency

Does your cat hunt? If yes what type of prey do they catch and do they bring it into the house?*
Do you have a scratching post? If yes please state how many, describe them, if your cat uses them and state where they are located.*
Who interacts the most with your cat?*

Methods & History Please select any that you use/have used:*

Rows	Currently using	Have used in the past	Never Used
Reward based methods
Praise
Telling off
Harness & lead
Water spray
Correction
Loud noise
Treats
Time out
Cool down area
Clicker
Normal flat collar
Clapping
Poking
Withholding attention
Other (please write below)

Other method (if not listed above):
I have already had some form of 121 helpMy cat has attended some form of kitten party or classNone apply
If you have had some form of training or behaviour help please detail: trainer/behaviourist name, company name, how many sessions, what you had help with*
Write N/A if this does not apply

Have you taught your cat do do any tricks or exercises? If so please rate them below:*

Rows	Not trained	Sometimes	Most of the time	All of the time, in any location
Sit
Spin
Down
Come
Wait
Follow me
Fetch
Bed
Other (write below)

Other exercise:*
What is your cat's favourite reward?*
Who is your cat most responsive to?*
What method is your cat most responsive to?*
Health & Medical
Veterinary Practice*

Name

Street Address

CityState / Province

Postal / Zip Code
Veterinary Surgeons Name*

First NameLast Name
Practice Phone Number*

Area CodePhone Number
Practice Email*
example@example.com
Previous or Current Conditions:*
Describe and include any tests or procedures please include things like fur balls or fight injuries.
Previous or Current Medications including the dose:*
Describe, name, dosage, duration. Please include any remedies you have tried
Vaccination status & last worming date:*
How does your cat react to examinations?*
What types of food (and specific brands) do you feed your cat?*
How much is eaten per day (state actual weight), what type of bowl is this out of, where is the bowl placed? *
What time/s are meals and who feeds your cat? *
How much fluid does your cat drink each day (ml/L), please state if this is milk or water or a combination. *

Appetite & Elmination *

Rows	Normal	Decreased	Increased	Eat Slowly	Eats Quickly
Drinking
Appetite
Defecation
Urination

Section Four: Reaction Information: multiple choice
Please download this multiple-choice form, complete it and upload it below

WORD VERSION - click here

PDF VERSION - click here
Upload Section Four *

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Upload your completed form here Cancelof

Section Five: Toilet Habits

Skip this section if you have no issues with toileting
Main toilet location?

Toileting Questions

Rows	Yes	No
Do you provide litter trays?
Does your cat regularly use the tray?
Does your cat every eliminate outside of the litter tray (say in a garden etc)

How often do you scoop the litter tray?
How often is the litter tray completely emptied and cleaned?
What is the litter substrate being used?
Is it scented?
How many litter trays do you have?
What size is each litter box?
What type of litter tray do you use (open/hooded etc)
How deep is the tray/trays
Do you use tray liners?
If so, are they scented?
How many cats share the litter boxes?
Please describe your cats behaviour in the litter box (dig, stand half on the outside etc)
Does your cat eliminate in secret or when there are people/animals around?
Will your cat immediately use a freshly cleaned tray?
Does your cat ever vocalise whilst eliminating?
Does your cat spray urine?
Does your cat ever use a shower, tiled floor or bath tub to eliminate?
Your reaction when it is in the wrong place:
When does your cat toilet in the wrong place?

Please select any/all that apply for toileting in the wrong place

Rows	Daily	Couple of times per week	Couple times per month	Where sleeping	On soft furniture	Anywhere
Urinate
Deficate

Anything else to add?

Section Six: Separation Information
How long is your cat left on average each day, what time?*
What arrangements are in place when you are away from home for a while (on holiday for example)?*
If your cat is left at a cattery or with relative, how do they react?
If your cat is ever left outside please state how they react?
Please upload a floor plan of your house highlighting key areas such as where litter trays are kept, entrance points, favourite sleeping locations etc. A rough sketch is fine, it doesn't need to be fancy. *

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Section Seven: Behaviour Problem

This section is for more details on the answers you have already provided above
MAIN ISSUE:*
What is the MAIN issue you are seeking help with
When did you first notice the problem/ what age?*
How does this impact you? What are your concerns?*
Frequency: how often do you experience the problem, how long does it last for?*
Cause: do you think anything caused the issue/s, or were there any significant household changes at the time?*
Cats Reaction: What triggers the problem, can you interrupt your cat? How does your cat behave afterwards?*
Body Language: what type of body language have you noticed during this incidents?*
ie fur raised, ears up, tail position, trying to run away etc?
Family reactions: how do you deal with the problem/s, what have you tried? Did anything help?*
Please give a detailed description of the last incident:*
List any drugs, supplements, or diets tried:*

Severity of the problem on a scale of 1 – 10 (10 being the worst):*

	1	2	3	4	5	6	7	8	9	10

1 is Best, 10 is Worst

SECOND ISSUE:*
What is the SECOND issue you are seeking help with. If there is no second issue just put N/A in each box
When did you first notice the problem/ what age?*
How does this impact you? What are your concerns?*
Frequency: how often do you experience the problem, how long does it last for?*
Cause: do you think anything caused the issue/s, or were there any significant household changes at the time?*
Dogs Reaction: What triggers the problem, can you interrupt your cat? How does your cat behave afterwards?*
Body Language: what type of body language have you noticed during this incidents?*
ie fur raised, ears up, tail position, trying to run away etc?
Family reactions: how do you deal with the problem/s, what have you tried? Did anything help?*
Please give a detailed description of the last incident:*
List any drugs, supplements, or diets tried:*

Severity of the problem on a scale of 1 – 10 (10 being the worst):*

	1	2	3	4	5	6	7	8	9	10

1 is Best, 10 is Worst

Please give a detailed description of the last incident:*
THIRD ISSUE:
Is there a THIRD issue you are seeking help with.
When did you first notice the problem/ what age?
How does this impact you? What are your concerns?
Frequency: how often do you experience the problem, how long does it last for?
Cause: do you think anything caused the issue/s, or were there any significant household changes at the time?
Dogs Reaction: What triggers the problem, can you interrupt your cat? How does your cat behave afterwards?
Body Language: what type of body language have you noticed during this incidents?
ie fur raised, ears up, tail position, trying to run away etc?
Family reactions: how do you deal with the problem/s, what have you tried? Did anything help?
List any drugs, supplements, or diets tried:

Severity of the problem on a scale of 1 – 10 (10 being the worst):

	1	2	3	4	5	6	7	8	9	10

1 is Best, 10 is Worst

Do you have more than THREE issues? If you do please detail them in a separate document following the questions in the order they are above and attach it as a file.

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Tell us about a fourth or more issues. Cancelof
Section Eight: Additional Information

Have we missed anything?
Do you have any conditions we need to be aware of that need special consideration during your sessions? (anxiety, learning difficulties, physical impairment etc). This information ensures we tailor our service to meet your needs. *
Write N/A if nothing else to mention
Do you have any previous history or trauma with animals's that might need consideration (such as having a previous cat with behaviour issues). This might help us understand any concerns you have with more depth *
Write N/A if nothing else to mention
Please upload any other supporting documents you feel are relevant and want to share.

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Section Nine: Signature Required
Yes
Appointments are subject to availability and might change between your inquiry and your completion of this process. You will unlock access to the diary once you have purchased your behaviour programme. Once purchased this will trigger automated emails for you to book your own appointments in the diary.

In submitting your questionnaire and proceeding with a programme you agree to the full terms and conditions which can be viewed here.
Yes
I confirm I have completed this form to the best of my knowledge and agree to the terms and conditions of service as per booking. Full terms and conditions, and privacy policy are available to view on the website here.

Please do contact me if your situation changes. I look forward to meeting you and your dog.
PLEASE NOTE: When you click on this field to complete your browser might push the box further up the page. Please scroll up if you click to complete but cannot view it and it will be there.

DATE: Date* First Name* Last Name*
Signature*

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Feline Behaviour Questionnaire

Section One: Owner Information

Section Two: Cat's Information

Health & Medical

Section Three: Reaction Information

Section Four: Reaction Information: multiple choice

Section Five: Toilet Habits

Section Six: Separation Information

Section Seven: Behaviour Problem

Section Eight: Additional Information

Section Nine: Signature Required