Feline Behavior and Health History Form

Feline Behavior and Health History Form

If there are multiple cats involved, please fill out one form for each of them. After you complete this form, please check your confirmation email for a scheduling link.
Information about you
Full Name

First NameLast Name
Preferred Pronouns
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about Blissful Cat Behavior Consulting? Is there someone I can thank for a referral?
Information about your cat
Cat's name:
Cat’s age and/or date of birth (estimate if you aren’t certain):
When did this cat join your family?
Cat's sex and alteration status:
Please attach a photo of your cat.

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Cat's breed:
Cat's weight (estimate if you aren’t certain):
Is your cat declawed on any of their paws?
Name of primary veterinary clinic and preferred veterinarian:
When was your cat’s last vet visit?
What kind of food does your cat eat? How much and how often?
Does your cat go outside?
Does your cat have any existing medical conditions? If yes, please describe them.

Please list any medications your cat currently takes. Include medications that they may take prior to vet visits or stressful events. Please write "none" in the first box if they don't take any medications.

Rows	Name of medication	How many mg or ml in a single dose?	How often do they take this medication?	What is their response to the medication?
1
2
3
4

What type of home do you live in?
What do you know about your cat’s early life? Did they interact with humans or other animals?
Describe your cat’s personality.
Describe the behavior challenges you’re having with your cat. Please include as much relevant detail as possible.
How long has this problem been going on?
Do you suspect any causes or contributions to the problem?
What steps have you already taken to resolve the problem? What has been effective or ineffective?
Have you ever worked with a veterinarian or another behavior professional for this issue? If you have, who?
How does your cat typically respond to visitors to your home?
Does your cat show aggression (swatting, hissing, lunging, biting) towards you or other people/animals in the home?
Does your cat show aggression (swatting, hissing, lunging, biting) towards veterinarians, groomers, or other animal care professionals?
How do you respond when you see your cat "misbehave?"

Please provide information about the humans who share a home with this cat.

Rows	Name	Age	Relationship to you	How do they get along with the cat?
You
Other
Other
Other

Are there any other animals in the home? Please list their names, ages, breed, and species.

Rows	Name	Species/Breed	Sex	Age	How do they get along with the cat?
Animal
Animal
Animal
Animal
Animal

What are your goals for working with me? What kind of behavior change would you like to see?
Under what conditions would you consider rehoming this cat or surrendering them to a rescue?
Is there any other information that you'd like for me to know about you or your cat?
Tell me something that you love about your cat!
Please check your email for the appointment scheduling link after clicking "submit"

You will get a message titled "We have received your response for Feline Behavior and Health History Form." The link to schedule your first appointment is inside! Email me at luke@blissfulcatbehavior.com if you have any questions.
Should be Empty:

Feline Behavior and Health History Form

Information about you

Information about your cat

Please check your email for the appointment scheduling link after clicking "submit"