Feline Behavioral History 2025

1
Todays Date
Date
Month
Day
Year
2
How did you find us or who referred you
3
Name
4
Address
5
Email
example@example.com
6
Phone Number
7
Name
8
Email
example@example.com
9
Phone Number
10
Pets name
11
Sex
12
Age
13
Coat Color
14
Breed
15
Date of birth
Date
Month
Day
Year
16
Neutered/Spayed?
17
Weight
18
Clinic name
19
Clinic phone number
20
Dr Name
21
Basic description of problems (e.g, .destructions when left alone urinating in the house bite to visitors in the home)
22
Age at which problem began
23
Severity
Very serious
Serious
Not Serious
24
Is it getting better or worse
25
Please list the people, including yourself, living in your household. Briefly describe the way each person interacts with the dog and how the dog reacts to this person.
Huge
Large
Normal
Small
Ok
Ok
26
How often do the members of your family have conflicts regarding how to handle the dogs behavior problem
Never
Sometimes
Always
27
Please list ALL the animals in the household IN THE SEQUENCE THEY WERE OBTAINED. Also briefly describe the nature of the dogs interaction with this peteg occasional growls little interaction friendly etc
Huge
Large
Normal
Small
Ok
Ok
28
How old was your cat when you first acquired him/her?
29
Where did you get your cat?
30
Was your cat orphaned?
31
Orphaned with littermates?
32
Bottle fed?
33
If orphaned, did it have contact with other: Non-related adult cats?
34
If known, how much time per day was the orphaned cat in contact with other cats?
35
Has this cat had other owners?
36
Why was the cat given up by the previous owner?
37
Did you meet your cat’s parents or do you have any information about littermates? Yes No If yes, please describe
Huge
Large
Normal
Small
Ok
Ok
38
Briefly describe your cat’s behavior as a kitten (e.g. activity level, response to instructions, shy/outgoing, litterbox use):
Huge
Large
Normal
Small
Ok
Ok
39
The following chart provides information about aggression, its intensity, and in what situations it is elicited. For each situation listed, check your cat’s worst reaction in the past. These questions refer to situations in the past. Please do not do these things to determine your cat’s reaction. If he or she has never been in a particular situation, please check “situation does not apply”. Please indicate the target of aggression (e.g. person or animal) for the appropriate situation.
No Aggression
Growls, swats, shows other aggressive behavior without biting
Bites (makes contact)
Situation does not apply
Target of aggression
Family member pets cat
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Family member lifts cat
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Family member approaches cat while resting
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Cats ears or eyes are cleaned or treated
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Cats nails are trimmed
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Cat is brushed/combed
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Another cat approaches cat while eating
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Cat encounters another cat near the litter box
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
Row 7, Column 4
Another cat approaches/disturbs cat while resting
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
Row 8, Column 4
Dog approaches/disturbs cat while resting
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
Row 9, Column 4
Veterinary/staff member handles/examines cat
Row 10, Column 0
Row 10, Column 1
Row 10, Column 2
Row 10, Column 3
Row 10, Column 4
Unfamililar person (adult) approaches cat
Row 11, Column 0
Row 11, Column 1
Row 11, Column 2
Row 11, Column 3
Row 11, Column 4
Unfamiliar person (adult) speaks to/pets cat
Row 12, Column 0
Row 12, Column 1
Row 12, Column 2
Row 12, Column 3
Row 12, Column 4
Response to infants or toddlers
Row 13, Column 0
Row 13, Column 1
Row 13, Column 2
Row 13, Column 3
Row 13, Column 4
Unfamiliar cat approaches/passes window while cat is indoors
Row 14, Column 0
Row 14, Column 1
Row 14, Column 2
Row 14, Column 3
Row 14, Column 4
Unfamiliar cat approaches/interacts with cat outside
Row 15, Column 0
Row 15, Column 1
Row 15, Column 2
Row 15, Column 3
Row 15, Column 4
Family member pets cat
Family member lifts cat
Family member approaches cat while resting
Cats ears or eyes are cleaned or treated
Cats nails are trimmed
Cat is brushed/combed
Another cat approaches cat while eating
Cat encounters another cat near the litter box
Another cat approaches/disturbs cat while resting
Dog approaches/disturbs cat while resting
Veterinary/staff member handles/examines cat
Unfamililar person (adult) approaches cat
Unfamiliar person (adult) speaks to/pets cat
Response to infants or toddlers
Unfamiliar cat approaches/passes window while cat is indoors
Unfamiliar cat approaches/interacts with cat outside
No Aggression
Row 0, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 0, Column 1
Bites (makes contact)
Row 0, Column 2
Situation does not apply
Row 0, Column 3
Target of aggression
Row 0, Column 4
No Aggression
Row 1, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 1, Column 1
Bites (makes contact)
Row 1, Column 2
Situation does not apply
Row 1, Column 3
Target of aggression
Row 1, Column 4
No Aggression
Row 2, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 2, Column 1
Bites (makes contact)
Row 2, Column 2
Situation does not apply
Row 2, Column 3
Target of aggression
Row 2, Column 4
No Aggression
Row 3, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 3, Column 1
Bites (makes contact)
Row 3, Column 2
Situation does not apply
Row 3, Column 3
Target of aggression
Row 3, Column 4
No Aggression
Row 4, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 4, Column 1
Bites (makes contact)
Row 4, Column 2
Situation does not apply
Row 4, Column 3
Target of aggression
Row 4, Column 4
No Aggression
Row 5, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 5, Column 1
Bites (makes contact)
Row 5, Column 2
Situation does not apply
Row 5, Column 3
Target of aggression
Row 5, Column 4
No Aggression
Row 6, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 6, Column 1
Bites (makes contact)
Row 6, Column 2
Situation does not apply
Row 6, Column 3
Target of aggression
Row 6, Column 4
No Aggression
Row 7, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 7, Column 1
Bites (makes contact)
Row 7, Column 2
Situation does not apply
Row 7, Column 3
Target of aggression
Row 7, Column 4
No Aggression
Row 8, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 8, Column 1
Bites (makes contact)
Row 8, Column 2
Situation does not apply
Row 8, Column 3
Target of aggression
Row 8, Column 4
No Aggression
Row 9, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 9, Column 1
Bites (makes contact)
Row 9, Column 2
Situation does not apply
Row 9, Column 3
Target of aggression
Row 9, Column 4
No Aggression
Row 10, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 10, Column 1
Bites (makes contact)
Row 10, Column 2
Situation does not apply
Row 10, Column 3
Target of aggression
Row 10, Column 4
No Aggression
Row 11, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 11, Column 1
Bites (makes contact)
Row 11, Column 2
Situation does not apply
Row 11, Column 3
Target of aggression
Row 11, Column 4
No Aggression
Row 12, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 12, Column 1
Bites (makes contact)
Row 12, Column 2
Situation does not apply
Row 12, Column 3
Target of aggression
Row 12, Column 4
No Aggression
Row 13, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 13, Column 1
Bites (makes contact)
Row 13, Column 2
Situation does not apply
Row 13, Column 3
Target of aggression
Row 13, Column 4
No Aggression
Row 14, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 14, Column 1
Bites (makes contact)
Row 14, Column 2
Situation does not apply
Row 14, Column 3
Target of aggression
Row 14, Column 4
No Aggression
Row 15, Column 0
Growls, swats, shows other aggressive behavior without biting
Row 15, Column 1
Bites (makes contact)
Row 15, Column 2
Situation does not apply
Row 15, Column 3
Target of aggression
Row 15, Column 4
1 of 16
40
Please complete the table below. Please check all that apply.
Hides
Escapes
Urinates
Defecates
Dilates pupils
Hisses
Vocalizes
Puffs up (fur/tail)
Cat is home with family
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Row 0, Column 7
Cat is alone at home or separated from family
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Row 1, Column 7
Visitors enters home
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Row 2, Column 7
Visitor approaches/ interacts with cat
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Row 3, Column 7
Another household cat approaches
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Row 4, Column 6
Row 4, Column 7
Household dog approaches
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Row 5, Column 6
Row 5, Column 7
At Veterinary office
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
Row 6, Column 5
Row 6, Column 6
Row 6, Column 7
New object is in the home
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
Row 7, Column 4
Row 7, Column 5
Row 7, Column 6
Row 7, Column 7
Loud noises
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
Row 8, Column 4
Row 8, Column 5
Row 8, Column 6
Row 8, Column 7
Unfamiliar animal approaches
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
Row 9, Column 4
Row 9, Column 5
Row 9, Column 6
Row 9, Column 7
Cat is home with family
Cat is alone at home or separated from family
Visitors enters home
Visitor approaches/ interacts with cat
Another household cat approaches
Household dog approaches
At Veterinary office
New object is in the home
Loud noises
Unfamiliar animal approaches
Hides
Row 0, Column 0
Escapes
Row 0, Column 1
Urinates
Row 0, Column 2
Defecates
Row 0, Column 3
Dilates pupils
Row 0, Column 4
Hisses
Row 0, Column 5
Vocalizes
Row 0, Column 6
Puffs up (fur/tail)
Row 0, Column 7
Hides
Row 1, Column 0
Escapes
Row 1, Column 1
Urinates
Row 1, Column 2
Defecates
Row 1, Column 3
Dilates pupils
Row 1, Column 4
Hisses
Row 1, Column 5
Vocalizes
Row 1, Column 6
Puffs up (fur/tail)
Row 1, Column 7
Hides
Row 2, Column 0
Escapes
Row 2, Column 1
Urinates
Row 2, Column 2
Defecates
Row 2, Column 3
Dilates pupils
Row 2, Column 4
Hisses
Row 2, Column 5
Vocalizes
Row 2, Column 6
Puffs up (fur/tail)
Row 2, Column 7
Hides
Row 3, Column 0
Escapes
Row 3, Column 1
Urinates
Row 3, Column 2
Defecates
Row 3, Column 3
Dilates pupils
Row 3, Column 4
Hisses
Row 3, Column 5
Vocalizes
Row 3, Column 6
Puffs up (fur/tail)
Row 3, Column 7
Hides
Row 4, Column 0
Escapes
Row 4, Column 1
Urinates
Row 4, Column 2
Defecates
Row 4, Column 3
Dilates pupils
Row 4, Column 4
Hisses
Row 4, Column 5
Vocalizes
Row 4, Column 6
Puffs up (fur/tail)
Row 4, Column 7
Hides
Row 5, Column 0
Escapes
Row 5, Column 1
Urinates
Row 5, Column 2
Defecates
Row 5, Column 3
Dilates pupils
Row 5, Column 4
Hisses
Row 5, Column 5
Vocalizes
Row 5, Column 6
Puffs up (fur/tail)
Row 5, Column 7
Hides
Row 6, Column 0
Escapes
Row 6, Column 1
Urinates
Row 6, Column 2
Defecates
Row 6, Column 3
Dilates pupils
Row 6, Column 4
Hisses
Row 6, Column 5
Vocalizes
Row 6, Column 6
Puffs up (fur/tail)
Row 6, Column 7
Hides
Row 7, Column 0
Escapes
Row 7, Column 1
Urinates
Row 7, Column 2
Defecates
Row 7, Column 3
Dilates pupils
Row 7, Column 4
Hisses
Row 7, Column 5
Vocalizes
Row 7, Column 6
Puffs up (fur/tail)
Row 7, Column 7
Hides
Row 8, Column 0
Escapes
Row 8, Column 1
Urinates
Row 8, Column 2
Defecates
Row 8, Column 3
Dilates pupils
Row 8, Column 4
Hisses
Row 8, Column 5
Vocalizes
Row 8, Column 6
Puffs up (fur/tail)
Row 8, Column 7
Hides
Row 9, Column 0
Escapes
Row 9, Column 1
Urinates
Row 9, Column 2
Defecates
Row 9, Column 3
Dilates pupils
Row 9, Column 4
Hisses
Row 9, Column 5
Vocalizes
Row 9, Column 6
Puffs up (fur/tail)
Row 9, Column 7
1 of 10
41
Other fears or anxiety
42
How many times has the cat bitten a person?
43
How many bites required medication attention?
44
Please describe the first and two most recent incidents in detail. Include date, people and animals present, location, trigger (e.g., visitor knocking on door), sequence of events leading to incident, how long the episode lasted, how you and target of aggression reacted, and how quickly the cat returned to normal behavior.
First incident:
Most recent incident:
Second most recent incident:
Comments
45
Type a question
Liner?
Dimensions? (LxWxD)
Location
Brand name of litter
Opened-top commercial litter box
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Covered box, “Cave” - type front door
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Covered box, “Booda” -type (cat crawls into hold on top of box)
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Automatic cleaning
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Opened-top commercial litter box
Covered box, “Cave” - type front door
Covered box, “Booda” -type (cat crawls into hold on top of box)
Automatic cleaning
Liner?
Row 0, Column 0
Dimensions? (LxWxD)
Row 0, Column 1
Location
Row 0, Column 2
Brand name of litter
Row 0, Column 3
Liner?
Row 1, Column 0
Dimensions? (LxWxD)
Row 1, Column 1
Location
Row 1, Column 2
Brand name of litter
Row 1, Column 3
Liner?
Row 2, Column 0
Dimensions? (LxWxD)
Row 2, Column 1
Location
Row 2, Column 2
Brand name of litter
Row 2, Column 3
Liner?
Row 3, Column 0
Dimensions? (LxWxD)
Row 3, Column 1
Location
Row 3, Column 2
Brand name of litter
Row 3, Column 3
1 of 4
46
Does your cat scratch the litter box before and after eliminating?
47
Does your cat cover feces?
48
Does your cat put all four feet in the litter box?
49
If not, where are the feet? (e.g. outside or edge of the litter pan)?
50
Does your cat Vocalize while eliminating?
51
Does your cat bolt out of the litter box after eliminating?
52
How often do you scoop your litter?
53
How often do you replace the litter?
54
How often do you wash the litter box?
55
What products do you use to clean the box?
56
Do you add any additives to the box (e.g. baking soda)?
57
If your cat is eliminating outside of the litter box, please draw a simple outline of your home’s floor plan.
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58
Is your cat: Indoors only, outdoors only, Primarily indoors, Primarily outdoors, Supervised while outside?
59
Other (please explain): Please do not include yard time
60
How many hours total does your cat spend outdoors, on average, per day?
61
Does your cat have access to the outside through a cat door?
62
If kept indoors, is your cat restricted to a specific area of room in the house? Please describe:
63
How many times do you play with toys or play games with the cat, daily (on average)?
64
How long does each play last, on average (in minutes)?
65
What toys does your cat have?
66
Do you use treat-dispensing toys? What type (brand name is known)?
67
What do you feed your cat? (Please be specific, e.g. brand name, canned vs. dry)
68
How many meals is your cat fed each day?
69
Does your cat finish each meal? If not is the food bowl left out all day?
70
Where is your cats food bowl?
71
Does your cat have any food allergies or diet restrictions? If yes, please describe.
72
What is your cat’s favorite treat (name brand or type of meat/seafood)?
Huge
Large
Normal
Small
Ok
Ok
73
Is your cat declawed? Front paws, hind paws or both?
Huge
Large
Normal
Small
Ok
Ok
74
Any complications after the surgery?
Huge
Large
Normal
Small
Ok
Ok
75
Medical ProblemsPlease list any previously diagnosed medical problems and how they were treated.
Date
Diagnosis
Treatment (including medications and dosage)
Outcome
Medical Problem
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Medical Problem
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Medical Problem
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Medical Problem
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Medical Problem
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Medical Problem
Medical Problem
Medical Problem
Medical Problem
Medical Problem
Date
Row 0, Column 0
Diagnosis
Row 0, Column 1
Treatment (including medications and dosage)
Row 0, Column 2
Outcome
Row 0, Column 3
Date
Row 1, Column 0
Diagnosis
Row 1, Column 1
Treatment (including medications and dosage)
Row 1, Column 2
Outcome
Row 1, Column 3
Date
Row 2, Column 0
Diagnosis
Row 2, Column 1
Treatment (including medications and dosage)
Row 2, Column 2
Outcome
Row 2, Column 3
Date
Row 3, Column 0
Diagnosis
Row 3, Column 1
Treatment (including medications and dosage)
Row 3, Column 2
Outcome
Row 3, Column 3
Date
Row 4, Column 0
Diagnosis
Row 4, Column 1
Treatment (including medications and dosage)
Row 4, Column 2
Outcome
Row 4, Column 3
1 of 5
76
Please list any BEHAVIORAL medications and supplements you have administered to your pet:
Name of medication
Amount given mg and frequency (i.e. 10 mg every 12 hours)
Date started/ stopped and Outcome (improved, worsened, no change)
Medical Problem
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Medical Problem
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Medical Problem
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Medical Problem
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Medical Problem
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Medical Problem
Medical Problem
Medical Problem
Medical Problem
Medical Problem
Name of medication
Row 0, Column 0
Amount given mg and frequency (i.e. 10 mg every 12 hours)
Row 0, Column 1
Date started/ stopped and Outcome (improved, worsened, no change)
Row 0, Column 2
Name of medication
Row 1, Column 0
Amount given mg and frequency (i.e. 10 mg every 12 hours)
Row 1, Column 1
Date started/ stopped and Outcome (improved, worsened, no change)
Row 1, Column 2
Name of medication
Row 2, Column 0
Amount given mg and frequency (i.e. 10 mg every 12 hours)
Row 2, Column 1
Date started/ stopped and Outcome (improved, worsened, no change)
Row 2, Column 2
Name of medication
Row 3, Column 0
Amount given mg and frequency (i.e. 10 mg every 12 hours)
Row 3, Column 1
Date started/ stopped and Outcome (improved, worsened, no change)
Row 3, Column 2
Name of medication
Row 4, Column 0
Amount given mg and frequency (i.e. 10 mg every 12 hours)
Row 4, Column 1
Date started/ stopped and Outcome (improved, worsened, no change)
Row 4, Column 2
1 of 5
77
What are your expectations for your appointment with Animal Behavior Consultants
78
Please check the statement that best describes how you are feeling about your dog’s behavior problem:
I am here only out of curiosity - the problem is not serious.
I would like to change the problem, but it is not serious
The problem is serious and I would like to change it, but if it remains unchanged that’s all right.
The problem is very serious and I would like to change it, but if it remains unchanged I will keep my cat.
The problem is very serious and I would like to change it. If it remains unchanged I will consider having my cat euthanized or give him/her up.
Should be Empty: