Behavior Assessment - Feline
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Overview
Individual completing this form.
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pet's name
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Pet's approximate age or date-of-birth, sex, spay/neuter status, breed or breed mixture, & most recent weight.
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Ex: 2 year old, neutered male, DSH, 9 lbs.
Photograph of pet
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Veterinary Clinic, Doctor, and Telephone Number
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Acquisition & Early History
How did you acquire this cat?
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Breeder
Shelter
Rescue
Friend or family member
Found it/stray
Other
What is the pet's history prior to acquisition?
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Approximate date and age of acquisition?
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If spayed or neutered, at what age was it performed?
How much interaction did this cat have with people and other animals during their first year of life?
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Briefly describe your pet's personality.
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Describe the problem(s) you are currently having.
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When did this start?
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What has been tried to correct the problem?
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Do you suspect any cause?
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Describe the last three incidents or episodes.
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Describe the cat's body posture during these episodes.
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What was your (or your family's) response to these episodes?
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What was your cat's reaction to your response?
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If there were aggressive behaviors, what was the result to the victim? (Check all that apply)
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Not applicable
No contact, just posturing
Bruise
Scratch
Shallow puncture (Less than 0.5 inches deep)
Deep puncture (Greater than 0.5 inches deep)
Tearing
Required medical treatment
Other
Are there any other pertinent details or comments you would like to share?
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Medical History
What do you feed your cat? Please provide name/formula, quantity fed, frequency of feeding, & crude protein percentage on the bag.
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Ex: Science Diet Adult Small Bites - 1/3 cup twice daily.
How would you describe your cat's appetite? Select all that apply.
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Poor, very picky
Good, eats normally
Voracious, always eating
Consistent
Sporadic
Please provide information about any routine products, medications, or supplements:
Name/Description
Amount/Dose
Frequency
Comments or Response
Preventatives
#1
#2
#3
#4
#5
#6
#7
#8
#9
#10
Please provide details about any chronic medical conditions your cat has, including diagnosis & treatment.
From the list below, please check any ailments your pet has experienced within the last year.
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Coughing
Sneezing (excessive)
Eye discharge
Nose discharge
Vomiting or regurgitation
Diarrhea or soft stool
Lameness or limping
Changes in activity level
Seizures
Surgery (besides spay/neuter, if applicable)
None of the above
Other
Does your pet have a relationship with any of the following veterinary specialists?
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Internal Medicine
Surgery/Orthopedics
Rehabilitation/Physical Therapist
Chiropractor and/or Acupuncturist
Ophthamologist
Dermatologist
Oncologist
Behaviorist
Other
Not Applicable
If you selected any of the above, please provide their name, facility, and telephone number.
Household & Daily Life
Please list the human occupants living in your home, whether part or full time.
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Name
Age
Occupation
Relation to you
Relationship (how they get along) with this cat
Yourself
#1
#2
#3
#4
#5
#6
#7
#8
#9
#10
Please list any other pets or animals living in your home, excluding the patient.
Name
Age
Sex, spay/neuter status
Species & Breed
Relationship (how they get along) with this cat
#1
#2
#3
#4
#5
#6
#7
#8
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In what sort of home do you and your pet reside?
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Single Family Home
Townhouse
Condo/Apartment
Other
How would you describe the energy in your home?
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Quiet, slow, routine oriented
Moderate activity, some sporadic changes
High activity, lots of coming & going, noisy
Have you owned a cat in your adult life prior to this one?
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Yes
No
How do you feed your cat?
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Out of a bowl
Feeder toys
Puzzle toys
As part of training
Hiding around the house
Where does your cat eat in relation to other pets in the household?
Do you need to be present for your cat to eat?
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Yes
No
Sometimes
Where does your cat spend most of their day?
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Where does your cat sleep at night?
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In a 24 hour period, how much does your cat sleep?
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Is your cat allowed outside?
No - Never
Yes - Always supervised on my deck, porch, yard, etc.
Yes - We go for leash or stroller walks
Yes - Unsupervised
If applicable, how much time does your cat spent outside each day?
Do you have a yard? If yes, check all that apply:
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Yes
No
Unfenced
See through fencing (picket, wire, etc.)
Privacy fencing
Small (Less than 0.25 acres)
Medium (0.25 - 1 acre)
Large (Greater than 1 acre)
Is there any time each day dedicated to play or exercise?
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Yes
No
Sometimes
Is your cat playful?
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Yes
No
Sometimes
Is your cat affectionate or cuddly with people in the home?
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Yes
No
Sometimes
Is your cat affectionate or cuddly with visitors to the home?
Yes
No
Sometimes
If you have multiple cats, do you ever see them snuggling or grooming each other?
N/A
Yes
No
Sometimes
Does petting (from a human) or grooming (from another cat) ever result in aggressive episodes?
Yes
No
Sometimes
If you have multiple cats, do you ever see one hissing, swatting, and running away from another?
Yes
No
Sometimes
If "yes" or "sometimes" to the above question, please provide more details about what happens, which cats are involved, and how frequently the episodes occur.
Does your cat like to scratch?
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Yes
No
Sometimes
Do they scratch inappropriate items?
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No
Yes
Sometimes
Any inappropriate chewing or consumption of non-food items?
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Yes
No
Sometimes
Any additional details around play, scratching, chewing, etc?
What does your cat do as you prepare to leave?
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Do you record or monitor your pet when they are home alone?
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Yes
No
Sometimes
What is the average length of time your pet might be left home alone?
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Does your cat exhibit any of the following behaviors as you are preparing to leave or once you are gone?
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Pacing and/or panting for extended periods of time
Vocalization including whining, crying, meowing, yowling
Destruction of doors, windows, or walls
Damaging inappropriate objects
Urination and/or defecation outside the litterbox
Excessive drooling
Vomiting
None of the above
Training & Learning History
How would you describe your cat's ability to learn?
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Poor
Average
Excellent
Is there any specific time devoted to training each day?
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Yes
No
Have you ever worked with another behavior specialist or trainer?
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Yes
No
If yes to any of the above, please provide some more details below.
How do you correct your cat when they misbehave?
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Any other comments pertaining to training?
Litterbox & Elimination Habits
How many litterboxes do you have?
Is/are your litterboxes covered?
Yes
No
Some of them are
What type of litter or litter system do you use?
Describe your cleaning routine.
Describe your cat's digging behavior:
Digs before eliminating
Digs after eliminating
Digs in the litter
Digs on the walls/sides of the litterbox
Digs just outside the litterbox on the floor or walls.
None of the above
Do you ever see your cat quickly running from the litterbox after eliminating?
Yes
No
Sometimes
Does your cat ever urinate outside the litterbox?
Yes
No
Sometimes
Does your cat ever defecate outside the litterbox?
Yes
No
Sometimes
Miscellaneous Behaviors
Does your cat demonstrate aggressive behaviors in any of the following circumstances? (Aggression is defined as any "distance increasing behavior" and can include stiffening, staring, growling, swatting, hissing, biting, etc.)
Primary owner
Co-owner
Children
Other people
Handling/Grooming
Petting/Hugging
Disturbing while resting
Disciplining
Taking away food
Taking away objects
Describe your cat's response in the following situations. Write N/A for situations that do not occur for your cat.
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Inside the home
Outside the home
Frequent Visitors
Occasional Visitors
Unknown females
Unknown males
Unknown children
Unknown dogs (on leash)
Unknown dogs (off leash)
Crowds/busy areas
Trucks, buses, cars, etc.
Any distress associated noises, storms, or fireworks?
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Yes
No
Sometimes
Thunderstorms
Fireworks
Other
Does your cat demonstrate any inappropriate sexual behavior?
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Yes
No
Is your cat protective of any part(s) of their body?
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Yes
No
If yes, what part?
How does your pet behave at the veterinary hospital?
Does your cat ever demonstrate any of the following behaviors?
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Chases lights or reflections
Chases shadows
Chases their tail/spins
Suckles on blankets, pillows, bedding
Excessively lick themselves
Excessively lick others
Excessively lick other surfaces
Cause injury to themselves from licking or chewing
None of the above
Are there any other behaviors your find objectionable?
Perspective & Expectations
Using the scale below, how would you rank your cat's overall behavior? 1 meaning the cat needs to be out of the house ASAP and 10 meaning they are perfect and nothing needs changing.
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1
2
3
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5
6
7
8
9
10
What is the family's thoughts on the current problem(s)?
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What are your goals for treatment? Expectations for change?
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Under what circumstances would you rehome this cat?
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Under what circumstances would you euthanize this cat?
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Any final thoughts, concerns, or topics you would like to discuss?
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