• Feline Behavior History Form

  • Please allow 30-45 minutes to complete this form. A copy of your responses will be emailed to you once submitted.

    Please email info@vetbehaviormn.com if you have any problems with this form!

  • Your Information:

  • Today's Date:*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Client's Date of Birth (If certain prescriptions are warranted, this will be needed)*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Please share your preferred pronoun(s)*
  • What is your preferred method of communication?
  • Format: (000) 000-0000.
  • Do you feel your cat has been directly or indirectly impacted by changes related to the COVID-19 pandemic?*
  • Please tell us how you learned about us:*

  • Household Information:

  • Please indicate any household changes that have occurred since acquiring this cat.*
  • Living Situation. Please check all that apply.*

  • Primary Care Veterinarian and Practice:

  • Format: (000) 000-0000.

  • Patient Information:

  • Date of Birth (Estimate if Unknown):*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Sex:*
  • Is your cat declawed?*
  • Date Rabies vaccine was given:*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Where did you obtain your cat?*
  • How many previous households has your cat lived in?*

  • Medication & Major Medical History:

  • Diet and Feeding:

  • Does your cat have any dietary restrictions?*
  • How often do you offer food?*
  • How is the food presented/offered?
  • Does your cat finish all of the food?*

  • Equipment:

  • Please indicate equipment you use with your cat.*
  • Tools used:*
  • How does your cat respond to catnip?*

  • Lifestyle:

  • Tell us about your cat's lifestyle*

  • Behavior Concerns:

  • Aggressive Behavior:

    Ex. Tense posture, intense/hard stare, growling, lunging, snapping, biting
  • Who is your cat aggressive toward?*
  • Has your cat displayed any of the following behaviors towards humans?*
  • Total bites to PEOPLE, where teeth have TOUCHED skin:*
  • How many of the bites to people have BROKEN skin:*
  • Bite Pattern to PEOPLE:*
  • Does your cat display aggression towards other animals?*
  • If your CAT is aggressive to another CAT in the home, indicate the triggering situations.*
  • Has your cat displayed any of the following behaviors towards other animals?*
  • Bite Pattern to ANIMALS:*
  • Total bites to ANIMALS, where bites have TOUCHED skin:*
  • How many of the bites to animals have BROKEN skin?*

  • Relationships Among Household Cats:

    Skip this section if the patient is the only cat in the household.
  • Do you notice any of the following between the patient and the cat listed above? Check all that apply.*
  • Do you notice any of the following between the patient and the cat listed above? Check all that apply.*

  • Elimination Behavior:

  • Type of Litter Used*
  • How often do you scoop the litter boxes?*
  • How often do you change the litter and clean the boxes?*
  • Does your cat reliably use the litter box?*
  • How do you clean the soiled areas outside of the box?*

  • Urination:

  • How often does your cat urinate outside the box?*
  • When your cat urinates, do you notice any of the following? Check all that apply.*
  • Where outside the box does your cat urinate? Check all that apply.*
  • Does your cat dig with their front paws before or after urinating?*

  • DEFECATION:

  • How often does your cat defecate outside of the box?*
  • How many times per week does your cat defecate in total?*
  • What is the consistency of your cat's stool? Check all that apply.*
  • Where does your cat defecate outside the box? Check all that apply.*
  • Does your cat dig with their front paws before or after defecating?*

  • General Screening Questions

  • Which of the following best describe your cat's sleep pattern?*
  • How does your cat react to the following sounds? Please indicate all that apply.*
    Rows
  • Do you have any concern that your cat is anxious when you are gone?*
  • What does your cat do when you prepare to leave? Check all that apply.*
  • When your cat has been left home alone, do you typically come home to find that your cat was sleeping?*
  • Does your cat exhibit any of the following to the point of interfering with normal function? Check all that apply.*
  • How do you react when your cat behaves in an undesired way? Check all that apply.*
  • If you or another family member handle your cat, which behaviors do you observe?*
    Rows
  • Which behaviors do you observe with a VISITOR?*

  • Your Sentiments and Goals

  • What are your feelings on the potential use of medications IF recommended as part of your pet's treatment plan?*
  • We understand having a cat that is experiencing behavior challenges can be difficult. We would like to know and understand more about your relationship with your cat(s).*
  • Are you concerned that you may have caused the problem?*
  • Do you feel guilty about the problem?*
  • Have you considered finding another home for this cat due to behavior concerns?*
  • Have you considered euthanasia for this cat due to behavior concerns?*
  • Has anyone told you you should euthanize your cat?*
  • Did you seek help prior to this appointment?*
  • If yes, please indicate who you have received help from*
  • Do you feel that your goals or expectations for your cat are attainable?*
  • Ongoing behavior therapy is often recommended as part of a patient's treatment plan. Do you have an interest in pursuing ongoing behavior therapy/training following your Intro to Behavior Therapy appointment with your cat's Behavior Therapy team member?*
  • How involved would you like to be in your cat's treatment plan?*
  • If applicable, how involved would other household members like to be in your cat's treatment plan?*

  • We strongly recommend that all primary adult caregivers in the household, including spouses, partners, and other significant caretakers, attend the initial diagnostic, assessment, and treatment planning appointment. If teenagers are substantially involved in the pet’s daily care or interactions, their participation at this initial visit is also encouraged. Ensuring that all key members are present supports a unified understanding of the diagnosis, recommendations, and behavior modification plan from the outset.

  • Please do the following on the DAY OF your in-clinic appointment:

    This appointment is a brief 15-minute long appointment in conjunction with your virtual consultation with the doctor.
  • Should be Empty: