The Good Steward Training Company's Behavior & Welfare Pre-Consultation Questionnaire for Cats
We appreciate you taking the time to fill out this form thoroughly! This form provides us with the necessary information to best serve you and your animal companion. Please answer ALL of the questions in this form. If something does not apply to your animal companion, please note this in the answer box.
Getting to Know You
How should we refer to you?
First Name
Last Name
What are your pronouns?
Please List Your Primary Email Address:
example@example.com
Please List Your Home Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please List Your Primary Phone Number:
Please enter a valid phone number.
May we text you at this number?
Yes
No
Please let us know how you found us!
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Scheduling Information
The information provided below helps us to offer everyone the days and times that will best fit their schedule. Scheduling is done via phone or email and the days and times may vary as needed to ensure you and your pup are assisted in a timely manner.
Which of our Services are you interested in after our consultation?
In-Person Coaching Lessons (Training session with you present)
Trainer Takes the "Lead" (Training session without you present)
I am seeking assistance because my animal companion:
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Getting to Know Your Animal Companion
What is their name?
What is their sex and status?
Spayed Female
Intact Female
Neutered Male
Intact Male
How old are they?
If you are seeking welfare and behavior assistance for more than one individual, please fill out a separate form for each.
This is the only animal
I will be filling out multiple forms
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Medical History
Please list your current veterinarian's Name and Phone Number
Do we have your permission to request your pet's medical records from this vet?
Yes
No, I will email them to you
Is your animal companion up to date on their rabies vaccine?
Yes
No
When was your animal companion given their most recent rabies vaccine?
 -
Month
 -
Day
Year
Date
Was this a 1 year or 3 year vaccine?
1 Year
3 Year
What is your animal companion's heartworm status?
Heartworm Negative
Heartworm Positive
Unknown
When was the date of their last heartworm test?
 -
Month
 -
Day
Year
Date
What monthly preventative do you utilize to combat fleas, ticks, and heartworm?
Does your animal companion have any food allergies or food sensitivities?
Yes
No
If you answered yes to the question above, please list their allergies / sensitivities.
Does your animal companion have any current illnesses or injuries?
Yes
No
Does your animal companion have any chronic or reoccurring medical issues?
Yes
No
If you answered "yes" to either question above, please list the specific illness, injury, or medical issue below and include the date(s) this began.
Has your animal companion had any previous illness, injury, or medical issue that required veterinary treatment?
Yes
No
If you answered yes to the question above, please list the specific illness, injury, or medical issue and include the date(s) it began and was resolved.
Has your animal companion had any surgeries besides their spay/neuter?
Yes
No
If you answered yes to the question above, please list the specific surgeries and their dates below.
Besides their monthly preventative, is your animal companion on any current medications?
Yes
No
If you answered yes, please list ALL current medications and provide the following details: their dosage (amount and frequency) instructions, what they are being given for, and when these medications were first given.
Has you animal companion previously been on medications that are no longer is use?
Yes
No
If you answered yes, please list ALL previous medications and provide the following details: what they were given for, when they were started, when they were discontinued, and why they were discontinued.
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Developmental History
When did your animal companion join your family?
 -
Month
 -
Day
Year
Date
How old were they when you brought them home?
How did you acquire them?
Shelter / Rescue
Breeder
Private Rehoming from a Friend
Private Rehoming from a Stranger
Other
If your animal companion came from a shelter, rescue, or breeder please provide the name of this individual / organization below.
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Environmental History
How many people live in the home with your animal companion?
Please list all human members of the household with their age
How many animals live in the home with the animal companion you are seeking assistance for?
Please list all non-human members of the household and indicate their species, age, sex and status, and if they joined the home before or after this individual. (Example: Rocket - Cat, 6yr, Neutered Male, Before.)
Do any of the other animal family members have behaviors of concern including general anxiousness, storm anxiety, over-arousal, reactivity, resource guarding, etc?
Yes
No
If you answered yes to the question above, please provide a brief description of the behaviors of concern. (Example: Over grooming)
Do you have family, friends, or other professionals who assist in caring for your animal companion or watch them while you are out of town?
Yes
No
If you answered yes to the question above, please note these individuals below. (Ex: Susan - Neighbor, Petsits / Sally - Grandma, Visits Often or Petsits / John - Dogwalker)
We live in a:
Apartment / Condo
Manufactured Home
Townhome / Rowhome
Single Family Home
Other
If applicable, we live:
On the 1st Floor
On the 2nd or higher floor
Not Applicable
Our cat lives (please select all that apply)
Indoors
Freely roams outdoors
Closed in patio / porch
Roams within backyard
Have their been any changes in the household in the last 3 months? (New person or animal living there, construction, death of a family member, person or animal moving out, etc). If so please note what this change was and when it occurred.
I currently feed my animal companion
Dry Food / Kibble
Wet Food
Freeze-Dried or Refrigerated Food
Raw Food
Homemade Food
Please list the Brand and Diet that you feed daily (Ex: Purina ProPlan Sport).
I provide most meals (75%) in:
A bowl
A slow feeder bowl
A puzzle or treat dispensing toy
A lick mat, kong, or snuffle mat
During Training
I Vary it Frequently
Other
They usually eat:
100% of their food right away
100% of their food within a few hours
100% of their food by the end of the day
Between 75% and 100% of their food daily
Between 50% and 100% of their food daily
Less than 50% of their food daily
Their daily intake varies frequently
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Social History
Has your cat ever gotten into an altercation with another cat?
Yes, but no one was injured
Yes, they were injured but did not need medical treatment
Yes, they were injured and needed medical treatment
Yes, the other cat was injured but did not need medical treatment
Yes, the other cat was injured and needed medical treatment
Yes, multiple times
No
If you answered yes to the question above, when did the first altercation take place?
Over time the altercations have
Increased in frequency
Decreased in frequency
Remained the same in frequency
Had very variable frequency
Over time the altercations have
Increased in intensity
Decreased in intensity
Remained the same in intensity
Had very variable intensity
Do you feel you can identify the primary trigger(s) causing the altercations?
Yes
No
If you answered yes to the question above, please list the trigger(s).
Please provide details about the altercations that have occurred in the home. As much as possible, include for each: when it occurred, the context around the altercation, and the outcome of the altercation.
How does your cat react to strangers in the home?
Upset / Afraid (hides, hisses, swats)
Unsure (Keeps distance, approaches with caution)
Social (approaches confidently, accepts petting)
Friendly (likes to play, demands attention)
Has your cat ever bitten a person?
Yes
No
Yes, a few times
Yes, often
I feel like my cat is unpredictable
Yes
No
In some situations
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Behavioral History
Have there been any instances of urination / defecation outside of the catbox since potty training was completed?
Yes
No
If yes, how often does this occur and when did it last occur?
Have there been any instances of destructive behaviors in the home since house training was initially completed?
Yes
No
If yes, how often does this occur and when did it last occur?
If yes, what has been destroyed?
When we are away from home my animal companion is:
Free roaming in the house
Has part of the house or a specific room
Is secured in a pen
I have a camera that I use to monitor my animal companion when I am not home
Yes
No
During storms and/or fireworks my animal companion seems
Unbothered / No change
Slightly on edge, may pant or seek comfort from me
Afraid, may drool or pace or hide
Panicked, may destroy things or hurt themselves
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Training History
I have tried to teach my cat:
On my own
By having a trainer come to our home
I have not tried to train my cat
I or a trainer have used these tools while teaching my cat:
Supplements
Medications
Treats
Toys
Praise and Affection
Other Reinforcers
A remote collar that makes a noise, vibrates, or shocks
A crate, pen, or baby gate
A spray such as water, air, or citronella
Verbal corrections such as "no" or "uh uh"
Yelling
Scolding
Hitting or Swatting Physically
Other
Name of previous professional trainer / name of the business
Start and End date of working with this trainer
What did you ask this trainer to help you with?
Please briefly describe the types of exercises you and this individual did with your cat.
Please briefly describe the outcome of this experience. (Did the behavior get "better" or "worse", did it go away but then come back, etc).
If you worked with more than one trainer previously, please use this space to provide the following information about each trainer: (1) Business Name, (2) Dates that you worked with them, (3) any details you feel are important.
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Training Agreement
Media (photos of videos) of my animal companion taken during training can be utilized by the Good Steward Training Company on their social media platforms, website, and in educational or presentational materials.
Yes
No
Non-Staff including mentees and other trainers who adhere to the ethos of The Good Steward Training Company may assist with my cat's training:
Observe
Act as an assistant
None of the above
I understand that The Good Steward Training Company is providing guidance and support in regards to my animal companion's welfare and behavior. While they will be training my animal companion directly, I understand that the progress my animal companion makes is heavily impacted by my cooperation and effort and that the long-term success of my animal companion is contingent upon my continued willingness to provide them the support and guidance as instructed by my behavioral modification coach.
Yes, I understand and agree
No, I do not understand
No, I understand but I do not agree
I acknowledge that behavior is dynamic, learning is always taking place, and the day-to-day choices of my animal companion are influenced by many variables. I understand that, because of the nature of behavior, The Good Steward Training Company cannot make any guarantee regarding the outcome of any modification program. I understand that we may uncover information about my animal companion that requires additional work with a vet or vet behaviorist.
Yes, I understand and agree
No, I do not understand
No, I understand but do not agree
My coach my find it necessary to my animal companion's wellbeing and behavior success that I acquire items such as treats, enrichment puzzles, a muzzle, leashes, harnesses, or medication. I understand that I am responsible for the cost of these items, and that if I decide not to acquire recommended or necessary items it will impact my animal companion's welfare and/or success.
Yes, I understand and agree
No, I don't understand
No, I understand but I don't agree
My cat has exhibited aggression towards people prior to the date this form has been submitted.
Yes
No
My cat has exhibited aggression towards other animals prior to the date this form has been submitted.
Yes
No
Given my cat's history of aggressive behavior, I understand that they are now or may become a risk to the safety of others even with the behavioral support of The Good Steward Training Company. I am electing to seek behavior modification for my cat even though the exact outcome of this program cannot be guaranteed. During and after our work together, The Good Steward Training Company LLC can only be held liable for my cat's behavior during times in which my cat is being handled by or in the direct care of The Good Steward Training Company. I acknowledge that I am solely responsible for any damage my cat inflicts upon an animal or person at any and all other times.
Yes, I understand and agree
No, I do not understand
No, I understand but I do not agree
This does not apply to my cat
I understand that withholding information about my cat's prior behaviors and experiences puts others, including employees of The Good Steward Training Company and members of the public, at risk. I accept complete responsibility and liability for any harm that occurs as a result of lack of disclosure prior to training.
Yes, I understand and agree
No, I don't understand
No, I understand but I do not agree
I understand that the initial consultation will be billed individually and does not promise any further services by The Good Steward Training Company. I acknowledge that The Good Steward Training Company has the right to refuse services to me at any time for any reason not protected under discrimination laws.
Yes, I understand and agree
No, I don't understand
No, I understand but I don't agree
The Good Steward Training Company will always act in good faith. They agree to bring any disputes or concerns to me in a prompt manner. They agree to seek resolution through mediation prior to doing so through litigation. I agree to act in kind - to bring disputes or concerns directly to them in a prompt manner and to seek resolution through mediation before taking legal action.
Yes, I understand and agree
No, I don't understand
No, I understand but I don't agree
The Good Steward Training Company has a professional duty to provide a safe environment for my animal companion during learning. I agree that the Good Steward Training Company is only liable for harm either to or caused by my animal companion in cases where negligence on the part of The Good Steward Training Company can be proven.
Yes, I understand and agree
No, I don't understand
No, I understand but I don't agree
I understand that the terms and conditions set forth in this agreement cannot be modified or changed in any way after I submit this form unless the modification is agreed upon with witnesses and in writing by both parties. I have read and fully agree to all terms and conditions.
Yes, I understand and agree
No, I do not understand
No, I understand but I do not agree
By signing below I, as the legal owner of this animal, certify that everything stated above is accurate and truthful to the best of my knowledge. I herby waive and release The Good Steward Training Company, its owners, and its employees from all liability including but not limited to illness, injury, death, sickness, or damage unless direct and certain neglect or intent is proven. I certify that The Good Steward Training Company is not liable for my pets behavior at any time that my pet is not being handled by an employee and cannot be held responsible for my pets behavior outside of and after training.
Thank you for taking the time to fill out this questionnaire! We are honored by your choice to trust us with your animal companion's welfare and behavioral modification. We look forward to helping you succeed!
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