Questionnaire Behavioural Medicine

Questionnaire Behavioural Medicine - Cat

Please complete the following questionnaire as best you can. There are many questions, please do not feel you have to answer them in detail, we will have time for this during the consultation. The main aim is for me to have some information in advance, so I can prepare myself for you and your cat/s and also so that we can focus on the important points and not spend time collecting background information. Thank you in advance for your time!
Your email address
example@example.com
Your contact details
name

first namelast name
Address

street / house number

zip codeLand

citycountry
Phone number
Where did you hear about us?
Your cat
your cat's name
breed
sex
Did you observe any change in behaviour after castration? If yes, please describe
date of birth
current weight (in kg)
How would you describe your cat's personality?
What does your cat love most?
What are your cat's strengths? What do you love most about your cat?
The current problem
Behaviour: Please describe the current behavioural problem:
Beginning: How old was your cat when s/he started showing the behaviour? Please describe the first incident you remember:
Recovery: how long does it take your cat to recover from a stressful situation?
Reasons: Do you have an idea / a gut feeling as to why your cat is behaving like this?
Treatment attempts: What have you already tried to tackle the problem? How successful were the attempts? What worked, what didn't?
Worries: What is the biggest problem/worry for you?
Wishes: What do you hope to gain from the behavioural consultation?
Further information: Would you like to provide us with further information that is important to you regarding the problem?
Your cat's general behaviour

Behaviour: Does your cat exhibit the following behaviours? This is just an overview, we will go into more detail during the consultation, if necessary.

Rows	never	sometimes	often	previously, but not anymore	I don't know
flight
freeze
seeking proximity
trembling
excessive meowing/screaming
hissing
scratching
biting without injuries
biting with injuries
raising hackles
overgrooming him-/herself
scratching him-/herself excessively
chasing his/her tail, turning in circles
chasing shadows or lights
physical restlessness / nervousness
high arousability
panting
hypervigilance
destruction
following you around everywhere
other

Emotions: Do you feel your cat shows the following emotions?

Rows	never	sometimes	often	excessively	I don't know
fear
panic
anxiety
anger
irritation
frustration
sadness
depression
jealousy
happiness
positive anticipation
contentment
affection / love
empathy
gratitude
pride
curiosity
patience
other

In which situations does your cat seem stressed, anxious, aggressive or happy and how do you recognise this?

Rows	situation(s)	behaviours / signs
stressed
fearful/anxious
aggressive
happy

Does your cat play?

Rows	your cat's behaviours in these situations
alone
with other cats within the same household
with you
with familiar people
with unfamiliar people
with other animals
other

Elimination behaviour: Does your cat urinate outside the litter box?
Physical Health

You can answer briefly and we will go into more detail about your cat's physical health during the consultation. We would be very grateful if you could ask your veterinary practice to send us the medical history and results of previous medical examinations to admin@mayanimal.ch. Thank you very much!
Health: Is your cat currently suffering or has your cat previously suffered from physical symptoms or a physical illness?
Illnesses and symptoms: If your cat is currently suffering from or has previously suffered from any physical symptoms or illness, what are/were the symptoms and diagnoses, if any?
Surgeries: Has your cat ever had surgery? If yes, which ones and why?
Do you feel your cat might be in pain?

other
Sensitivity to pain: How would you rate your cat's sensitivity to pain?

1

2

3

4

5

1 is very high pain tolerance, very tough, 5 is very low pain tolerance, very sensitive to pain

Treatments: Are you currently giving your cat any medication or supplements or are you having your cat treated or have you done so in the past?

Rows	current	previously
Medication
Supplements
Manual therapy (e.g. osteopathy, chiropractice, acupuncture, etc.)
Other

Diet: what do you feed your cat?

Rows	brand / composition	time of day
dry food
wet food
home cooked
raw
other

Appetite: How is your cat's appetite?
Drinking: How much does your cat drink per day?
Vet visits: When was the last visit to the vet? Please state the reason and, if applicable, the diagnoses and treatments.
Further information: Would you like to give us any more information about your cat's physical health?
Should be Empty:

Questionnaire Behavioural Medicine - Cat

Your contact details

Your cat

The current problem

Your cat's general behaviour

Physical Health