Feline Behavior History Form

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!

Medication & Major Medical History:
Please list all medications and supplements your cat currently receives. Medication -- Dose -- How often given *
Ex. Gabapentin 100 mg capsule, 1 capsule prior to vet visits
Please list any past behavior medications your cat has received: *
Ex. trazodone, Fluoxetine, Gabapentin, Zylkene
If your cat has been prescribed medications for behavior, either in the past or currently, please specify the medication and dose and how your cat has responded when on a particular medication:*
If your cat has been given medications, please describe the method of administration. How did your cat respond to the medication administration?
Ex: Mixed in meal, mixed with treats, using a pill popper, manually administered orally.
Please list your cat's major medical procedures and illnesses: Ex. Hyperthyroidism, IBD, chronic vomiting, UTIs, recurrent upper respiratory infection*

Behavior Concerns:
Give a brief description of your top 3 main concerns for your pet. The following sections will ask for details.*
Concern #1*
Approximate or actual date or age problem began. After any particular incident?*
Please give us 3 examples of concern #1. *
Please include date (or estimated date if unknown). Include details such as location, who was present, a description of the event and what happened after the event.
Concern #2*
Approximate or actual date or age problem began. After any particular incident?*
Please give us 3 examples of concern #2*
Please include date (or estimated date if unknown). Include details such as location, who was present, a description of the event and what happened after the event.
Concern #3*
Approximate or actual date or age problem began. After any particular incident?*
Please give us 3 examples of Concern #3*
Please include date (or estimated date if unknown). Include details such as location, who was present, a description of the event and what happened after the event.

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.
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