Cat Behavior Questionnaire
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred method for a virtual consultation
Please Select
Phone call
Zoom
Webex
Pets Name:
Number of adults in the household (>18 years)
Number of children:
Number of cats in the house (including the patient):
Number of dogs in the house:
Number of other animals:
Who is the primary caretaker of the cat?
Please list all pets in the household: Name, breed, sex, age
Please list any current medical problems:
Current medications, vitamins, or supplements:
Origin
Own breeding
Breeder
Private home
Pet shop
Shelter/Rescue
Stray
Other
Don't know
If obtained as a kitten, how was the kitten raised?
In house
Kennel/garage
Loose outside
Other
Don't know
N/A
If obtained as a kitten, how did you select that particular kitten from the litter?
No choice
Most outgoing
Most timid
Biggest
Smallest
Prettiest
Other
N/A
Age removed from litter (If unknown please write "unknown"):
Age obtained (If unknown please write "unknown"):
If previously owned, for what primary purpose was the cat kept?
Pet
Show
Breeder
Farm/outside cat
Research/teaching
Don't know
Other
N/A
Is the cat declawed?
Yes
No
What is the primary purpose for which the cat was obtained:
Pet
Show
Breeding
Farm/outside cat
Other
Average number of hours the cat is left alone per weekday:
Schedule on weekends:
Is consistent
Varies
Where is the cat when left alone? (Select all that apply)
Cage
Confined in a room
Loose in living area
Outside
Basement
Garage
N/A
Where is the cat at night? (Select all that apply)
Cage
Confined in a room
Loose in living area
Bedroom
One person's bed
Outside
Basement
Garage
Average hours of being outside per day (N/A if cat is indoor-only):
Types of discipline (select all that apply):
None
Response substitution
Verbal reprimand (i.e. telling the cat "no.")
Startling (i.e. clapping or shaking a can of pennies)
Physical (i.e. tapping hind end)
Time-out
Water
Citronella spray
Air canister
Diet (select all that apply):
Dry
Canned
Table food
Other
Feeding schedule:
Once per day
Twice per day
More than twice per day
Free access
Feeding schedule:
Is regular
Varies
How many water bowls are down at one time?
One
Two
Three
Four
Five or more
How often is the water changed out?
Less than once per week
Once per week
Once every few days
Daily
Multiple times per day
Location of litter boxes (check all that apply):
Living area
Kitchen
Bathroom
Spare room
Laundry room
Closet
Basement
Hallway
Other
Type of litter box:
Open
Covered
Varies
Other
Type of litter (select all that apply):
Clumping
Clay
Shavings
Newspaper
Sand
Pine
Other
Is the litter:
Deodorized/scented
No odor control
Don't know
Type of litter:
Is consistent
Varies
N/A
Liners used:
No
Always
Varies
How often is the litter box scooped?
Less than one time per week
Weekly
Several times per week
Daily
Multiple times per day
N/A
How often is the litter box washed?
Less than once per month
Monthly
Weekly
Several times per week
Daily
N/A
How would you generally rate the cat's temperament?
Friendly
Aloof
Inhibited
Anxious
Hyperexcitable
Shy
Fearful
Aggressive
Don't know
Comments about temperament (if any):
What was the temperament of the cat as a kitten? (Check all that apply)
Friendly
Aloof
Inhibited
Anxious
Hyperexcitable
Shy
Fearful
Aggressive
Don't know
Please lits the problematic behavior and/or behavior concerns in order of importance to you (please cite specific incidents if applicable):
At approximately what age did you first notice the problem(s)?:
If anything, what have you tried so far to treat the problem(s)?:
How do you feel that your relationship is with your cat?:
What is your favorite thing about your cat?"
Submit
Should be Empty: