Hippocampus Online LYF Mentorship Cat Consultation Feline History

How did you hear about this service?

I agree to allow members of the "Land on Your Feet (LYF) Cat Behavior Consultant Mentorship" to attend my session for educational purposes.*

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I agree to allow members of the "Land on Your Feet (LYF) Cat Behavior Consultant Mentorship" to review this history form for educational purposes.*

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Agreement

Please review the Agreement below. Click "I agree" to accept and proceed.

I have reviewed the agreement above and hereby accept.*

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About This Cat's Legal Owner

Name*

Email*

example@example.com

Where does this cat currently live*

Street Address

Street Address Line 2

CityState / Province

Country

About This Cat

(if more than one cat is involved, describe primary cat)

Cat's Name*

Breed or mix (if known)*

Current Age*

Sex*

Neutered MaleMaleSpayed FemaleFemale

Declawed*

NoFront onlyAll 4 paws

Where did you get this cat?*

How old was cat when you acquired him/her? *

Describe what you know about this cat's history?*

How long has this cat lived with you?*

Concerning Behaviors

Most concerning behavior*

Other concerning behavior?

Additional concerning behavior?

How do you typically reward good behavior? (check all that apply)*

How do you typically punish/correct unwanted behavior? (check all that apply)*

Health/Nutrition

Date of most recent exam*

What occurred during the exam? (check all that apply)

Lifestyle

Describe all HUMANS in this cat's life*

Rows	First name	Age	Pronouns	Relationship (love, tolerates, dislikes, other)	Contact(live together, visits), other
1
2
3
4
5

Describe all ANIMALS in this cat's life*

Rows	Name	Age	Cat, dog breed, other?	Relationship (ex: Love, tolerate, dislike, other)	Contact (live together, visits, other)
1
2
3
4
5

Cat's typical exercise on an average day*

What is your cat's preferred play activity?*

Does cat go outside?

What does your cat have access to? (check all that apply)*

Rows	None	one	Multiple in one room	Multiple throughout home
scratcher
cat tree
litter box
Water fountain
enclosed deck/porch/catio
Food puzzle(s)

Have you discussed any behavior concerns with your vet? What advice did they give, if any?

List any current or past injuries or illnesses*

List any medications, supplements, etc. (including dosage)*

Please provide any relevant vet records, such as test results

Upload a File

Describe feeding*

Rows	Dry/kibble	Canned/pouch	Homemade	Raw
NA
Free choice
Scheduled
Via puzzle toy

What brand(s) of food do you feed?

List any food sensitivities or allergies*

Cat-Cat Conflict

Is this cat having issues with another cat?*

YesNo

Describe the other cat involved

Describe the current living situation

Additional details about the conflict

List any other cats the primary cat has conflict with

Litter Box Details

Is your cat eliminating outside of the box*

YesNo

WHERE in the home is the urine occurring?

What materials is cat URINATING on?

How would you describe the urination?

WHERE in your home is the feces occurring?

What materials is cat DEFECATING on?

How would you describe the defecation?

1. Very hard and dry, often expelled as individual pellets, requires much effort to expel from the body, leaves no surface residue when picked up.2. ∙ Firm, but not hard, pliable, Segmented in appearance, Little or no residue on ground when picked up3. Log shaped, moist surface, Little or no visible segmentation, Leaves residue on ground, but holds form when picked up4. Very moist and soggy, Log shaped, Leaves residue on ground and loses form when picked up5. Very moist but has a distinct shape, Present in piles rather than logs, Leaves residue on ground and loses form when picked up6. anything softer/looser than aboveUnknown

Describe your litter boxes

Rows	Location in home	Dimensions	Style (covered, top entry, auto, brand if any, etc)	Type of litter
Box 1
Box 2
Box 3
Box 4

Describe the litter you use

Rows	Brand	Scented?	Material (Clay, corn, paper, etc)	Regularly try new kinds
In box 1
In box 2
In box 3
In box 4

How often do you scoop?

Aggression

Is your cat displaying aggression toward humans?*

YesNo

Describe all victims

Rows	Name & age	Human, cat, other?	Live together, guest, other?
Victim 1
Victim 2
Victim 3
Victim 4

What types of injuries have occurred? (check all that are relevant)

Provide any additional information, victims, injuries, or incidents

Is there anything else you'd like to add?

Scheduling

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Donation

A donation is required in attempt to decrease "no-shows".

You will be asked to indicate where your payment should be directed.

payment info*

Pay for Your Cat Call$25.00

Check the box above to begin payment. Note the name "Firelink," which will appear on your statement, associated with this payment.

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Total $0.00

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