Cat Behavior History

Cat Behavior History Form
Person Information
Primary Caregiver Full Name*

First NameLast Name
Please select one or more options for the set(s) of pronouns you want people to use to refer to you:

she, her, hershe, him, histhey, them, theirsOther
Email
example@example.com
Phone Number
Please enter a valid phone number.
Other owner/caregiver name and pronouns
Other Phone
Address*

Street Address

Street Address Line 2

CityState

ZipCountry
Pet Information
Cat's Name*
Breed or looks like
Current Age*
Sex*

Spayed FemaleIntact FemaleNeutered MaleIntact MaleUnsure
Declawed*

NoFront onlyAll four paws
Microchip number if known
Where did you get this pet?
What do you know about this pet's history?*
How long has this pet lived with you?*
Family Make Up

Describes all HUMANS in this cat's life

	name	age	pronouns	relationship (live together, visit frequently, recent left/passed, get along, conflict, etc.)
1
2
3
4

Describes all ANIMALS in this cat's life

	name	age	species (cat, dog, bird, other)	relationship (live together, visit frequently, recent left/passed, get along, conflict etc)
1
2
3
4

Is your cat having issues with another pet(s) in your home? *

YesNo
Describe the other pet(s) involved
Have there been any recent changes in your pet's life (new pet or human family member, moving, renovation, etc.)?*

YesNo
Please describe the recent changes:
The Behaviors
Describe the behavior you most want to address*
Is there anything else you think is important to share about this behavior?
Describe any other concerning behaviors (list in order of priority)
Are you prepared for it to take time to resolve, up to several months or more?*

YesI can't do thatUncertain/undecided
Training History
How do you typically reward good behavior? (check all that apply)

PettingVerbal praiseTreats/foodToys/playI don't knowOther
How do you typically correct unwanted/bad behavior? (check all that apply)

Physical (Spanking, nose tap, squirt bottle, etc)Verbal (Scold, No!, AhhAhh!, Tsst!, etc)Noise (Clap hands, penny can, etc)I don'tOther
Please list any professionals (including veterinarians) you have discussed your concerns with and briefly describe their recommendations:
What have you specifically tried to resolve the problems in the past?
How did the pet respond to what you described above?

Got worseGot betterNo changeUncertainOther
Health, Nutrition, Exercise
Cat's typical exercise on an average day
Does cat go outside

NoAt scheduled times, comes in at nightIn/out wheneverOther
Has this cat been to a veterinarian while in your care?*

YesNo
If Yes, name of your vet clinic and the vet you prefer (if any)
Date of most recent exam and notable comments
List any current, recent, or past injuries or illnesses
List medications, supplements, etc. your pet is taking
List any food sensitivities or allergies
Describe this cat's feeding (check all that apply)

Dry kibbleCanned foodRaw or homemadeDry available all day/free choiceDry fed by scheduleCanned available all day/free choiceCanned fed by scheduleOther
How does this cat access water? (check all that apply)

BowlFountaincleaned dailycleaned weeklycleaned rarelyOther
Please submit any other relevant records (proof of up-to-date rabies vaccination required for in-home visits)

Cancelof
Litter Box Details
Is your cat urinating or defecating outside of the box*

YesNo

Does eliminating outside the litter box tend to occur at certain times of day or under certain circumstances? If yes, please describe.
Have you noticed anything that has increased or decreased the urinating outside the litter box? If yes, please describe.
Is your cat currently experiencing any of the following urinary signs. Select all that apply. * Note: male cats straining to urinate, seeming depressed/lethargic, and/or unable to produce urine should be seen urgently at a community veterinary practice or emergency room to rule out a potentially life-threatening condition called urethral obstruction.

Vocalizing while urinatingProducing small, frequent puddles of urineStraining to urinate with little urine producedDribbling urinePink or red colored urineNone of the above
What material(s) is the cat eliminating on? Select all that apply

In litter boxSoft flooring (carpet, area rugs, etc.)Hard flooring (wood, tile, linoleum, etc.)ClothingIn a bathtub, shower, or sinkPet beddingHuman beddingFurnitureOn new items in the homeOn items belonging specifically to one personOther
Where is the cat eliminating? Select all that apply

In the litterboxNear doorways and/or windowsIn the same location every timeNear litterbox (1 foot or less from box)Far from litterbox (more than 1 foot from box)Other
How would you describe the elimination? Select all that apply.

Large urine puddles on flat or horizontal surfaceSmall urine puddles on flat or horizontal surfaceUrine on vertical surfaces, such as wallsUrine is dark in color, smells funny or strong, etc.Feces is soft (like soft serve ice cream)Feces is firm, moist (like a soft Tootsie Roll)Feces if hard, dry (like an old Tootsie Roll)Other

What is the behavior of your cat while using the litterbox? Select all that apply

Stands with all four paws in the boxStands with only back paws in the boxStands on the edge, tries not to touch litterAlways covers urine/fecesRarely covers urine/fecesScratches at the wall, sides of box, or floor while coveringAlways looking out for other pets (may run if they come near)Never uses the litterboxUrinates in one box and defecates in anotherOther
How often do you scoop the litterbox?

Multiple times per dayOnce dailyA few times a weekWeeklyLess than weeklyOther
How often do you fully empty box, wash it, and replace litter?

At least weeklyA few times a monthAround once a month or moreOther
What type of litter do you currently use? Please include whether it is clumping or non-clumping, scented or non-scented, and the material - e.g. clay, pine, paper, crystal, corn, wheat, pee pads, etc. Please note if your cat has a preferred litter type.
If you have tried other litter types in the past, please list the type, how long you used it for, and whether your cat used it.
What steps have been taken to resolve the house-soiling? (check all that apply)

Changed location of litterboxChanged type of litterConfined cat to a smaller space with their litterboxAdditives to litter (baking soda, cat attract, etc.)Put food dishes in accident areaPunishmentMedicationUsed synthetic pheromone spray or diffuser in area (e.g. Feliway)Covered incident area to make it undesirable (e.g. sticky tape, foil, nubby mats, etc.)Changed type of litterboxCleaned box more frequentlyAdded another litterboxOther
What were the results of your attempts to resolve the house-soiling?
What methods/product(s) do you use to clean accident areas?
If you've had any medical testing or imaging done (e.g. fecal analysis, urinanalysis, xrays, ultrasounds, blood testing), please share the date of the most recent testing, the type of testing done, and the results.
What other comments do you have about this cat's litterbox behavior?
Destructive Scratching Details
Is your cat scratching your belongings?*

Yes and I want it to stopYes but I don't careNo
Describe your scratching posts. (check all that apply)

Have noneHave 1Have 2-3Have 4+Sisel ropeCardboardCarpetHangs or stands upright/verticallyLies flat/horizontally on the floorCat uses it regularlyCat uses it sometimesCat rarely or never uses itIs sturdy and doesn't move when cat scratches itWobbles, swings, or otherwise moves during scratchingOther
What kinds of surfaces are being scratched that you don't like?

Couch, chair, human bed, or other furnitureCarpet or throw rugsWoodwork, posts, or railsWalls, wallpaperWindow screensFabricLeatherWoodOther
Describe your cat's nail care (check all that apply)

No nail careCut nails with nail clippersGrind nails with nail grinderTrimmed weeklyTrimmed monthlyI trimVet trimsGroomer trimsSedation neededRestraint neededOther
Aggression Information
Is your cat displaying aggression (hiss, growl, swat, bite, etc.)?*

YesNo
How many aggressive incidents have occurred?
When did the aggression start? When was the most recent incident?
Describe the aggressive behaviors this cat has shown. Select all that apply.

HissGrowlSnapped only, no contactSwat, no contactSwat, contact but no broken skinShallow scrapes/scratch from clawsSwat, deep scratchOne or a few scratches that don't or barely bleedOne or a few scratches that bleedMultiple scratches that bleedBite, contact but no broken skinBite, caused bleedingBite, medical care neededMultiple bites in a single eventOther
Who is the aggression directed towards? Select all that apply.

Directed towards adultDirected towards childDirected towards catDirected towards dogVictim is a member of the householdVictim is familiar to cat, but not living in same householdVictim is a strangerOther
What was the victim doing immediately prior to the aggression?
Where was the victim in relation to the cat?
When is the aggression occurring? Select all that apply.

During pettingDuring handling or restraintWhen someone is walking pastAround food timeRandomlyIn homeOutdoorsAt vet, groomer, etc.During playWhen someone gets too closeOther
Is the cat exhibiting any warning signs prior to aggression? Select all that apply.

RetreatingTurning away/avoidingGrowlingTwitching tailSnappingFur standing upEyes dilatedNoneOther

Details of the most severe incident of aggression*
Is there anything more you'd like to share? Provide any additional behaviors and/or information.

	Location	height of lowest side	length/ width	other details (e.g. covered vs. uncovered, automatic/self-cleaning)
Box 1
Box 2
Box 3
Box 4

	Victim Name	Victim Type	Relationship	Injury	Details
Incident 1
Incident 2
Incident 3
Incident 4

	At least daily	At least weekly	At least monthly	Rarely	Never	Other
Urine
Feces

Cat Behavior History Form

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