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 Name
Last Name
Preferred Pronouns
*
Please Select
He/him
She/her
They/them
Other
Contact Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / 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 Select
Male, neutered
Female, spayed
Male, intact
Female, intact
Please attach a photo of your cat.
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of
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?
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What kind of food does your cat eat? How much and how often?
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Does your cat go outside?
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No.
Yes, without supervision.
Yes, but only when supervised.
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.
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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?
*
Please Select
Single family home
Apartment/Condo
Townhome
Other
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.
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How long has this problem been going on?
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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?
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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?
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Does your cat show aggression (swatting, hissing, lunging, biting) towards you or other people/animals in the home?
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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.
*
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.
*
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.
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