Feline Behavior and Health History Questionnaire
Please complete this form prior to your behavior appointment. Your detailed answers help us understand your cat’s background, environment, and current challenges.
Client Information
Client Name
*
First Name
Last Name
Email address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Patient Information
Pet’s Name
*
Pet’s Age or Date of Birth
*
Pet’s Gender
*
Female Intact
Female Spayed
Male Intact
Male Neutered
If applicable, date or age of spay/neuter
Pet’s Breed
*
Upload a picture of your cat to help us identify you when you arrive
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Primary Care Veterinarian Information
Veterinarian Name
Clinic Name
Veterinarian Email Address
example@example.com
Veterinarian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Acquisition & Background
How did you acquire your cat?
*
Breeder
Rescue/Shelter
Stray
Other
Date acquired
Do you know any prior history (before you acquired them)? If known, describe your cat’s interactions with people and/or other animals during their first year of life.
Household Environment
People living in the home
Other animals in the home
Type of home
Apartment
Condo
House
Other
Primary Behavioral Concerns
What is the main behavior concern you would like help with?
*
When did this behavior first start?
Were there any changes in the household or routine around the time this behavior began? (e.g., move, new person or pet, schedule change, illness, stressors)
Please describe the THREE most recent incidents in detail (what happened, who was involved, where it occurred):
How would you describe your cat’s body posture or signals during these incidents? (e.g., stiff, frozen, cowering, growling, tail position)
What was your reaction during these incidents?
If aggression occurred, what was the outcome?
No injury
Scratch
Bruise
Puncture
Tear
Other
Did the injury require medical attention?
No
Yes
If yes, please explain
How often does this behavior occur?
Daily
Weekly
Monthly
Rarely
Unpredictable
If house-soiling is a concern, does it occur when:
You are home
You are gone
Both
What have you tried so far to address this behavior (training methods, medications, etc)? Has anything helped or made it worse?
Any additional relevant details:
Is there any legal action pending related to this behavior?
No
Yes
If yes, please explain
Feeding & Food-Related Behavior
Where is your cat fed?
Is feeding separate from or near other pets?
How is food provided?
Bowl
Puzzle/foraging
Combination
Do you need to be present for your cat to eat?
Yes
No
Does your cat show protectiveness around food?
No
Yes – toward people
Yes – toward other animals
Sleep
Where does your cat usually sleep?
Bed
Couch
Cat bed
High places/perches
Other
Does your cat wake you at night?
No
Yes
If yes, please explain
Approximate total hours of sleep in a 24-hour period
Typical Daytime Routine
Where is your cat usually during the day?
Is your cat allowed outdoors?
No
Yes
If yes, how is access controlled?
How far does your cat typically roam (if known)?
How often do you see other cats outside your home?
Exercise, play, or enrichment activities
Training or discipline used (if any)
Separation & Alone-Time Behavior
What does your cat do when you prepare to leave?
How long is your cat typically left alone?
Do you record your cat when you are gone?
No
Yes
Behaviors observed when home alone
None
Urination in the house
Defecation in the house
Pacing or panting for long periods
Vocalization (barking/howling)
Excessive drooling/salivation
Destruction of household items
Refusal to eat
Other
Arrangements when you are out of town
Litter Box History
Number and location of litter boxes
Have you made any changes to litter boxes due to the current concern?
Type/size/shape of box
Brand/type of litter
Odor control products used
How often is waste scooped?
How often is the box completely emptied and cleaned?
What do you use to clean the box?
Does your cat use the litter box daily?
No
Yes
Elimination outside the litter box?
No
Yes
Frequency
How long has this been occurring?
Time of day
Inciting event (if known)
Have you witnessed it? Describe posture
Location
Horizontal
Vertical
Both
Intra-Cat Relationships (if applicable)
Does your cat defend territory from another cat (housemate or outside)?
Does your cat block or get blocked from access to food, litter boxes, rooms, toys, or perches?
Scratching Behavior
Is your cat declawed?
No
Yes
If yes, at what age?
Scratching posts available?
No
Yes
If yes, type(s)
Does your cat scratch objects you do not want them to?
No
Yes
If yes, please explain
Vocalization
When does your cat meow?
When does your cat hiss?
When does your cat growl?
When does your cat purr?
Travel-related behaviors
None
Avoids getting into car
Excessive drooling
Rapid breathing
Inability to settle
Vocalizing
Vomiting
Trembling
Hiding
Other travel-related behaviors
No
Yes
Aggression
Please check any situations where aggression has occurred:
Rows
Toward Primary Owner
Toward Other Adults
Toward Known Children
Toward Others
Handling/grooming
Petting/hugging
Disturbed while resting
Discipline
Taking food away
Taking objects away
Please explain (aggression situations):
Visitors & Novel Situations
Response to doorbell
Typical response to the following (hides, hisses, friendly, cautious, etc):
Rows
Response
Known People
Unknown People
Children
Animals in the home
Animals outside the home
Going outside
Being picked up
Grooming/Nail Trimming
Petting
Repetitive behaviors
Chasing lights/shadows
Tail chasing
Snapping at air
Suckling on self or blankets
None
Other
Other behaviors
Protective of specific body areas
Excessive licking/chewing self
Excessive licking/chewing objects
Fearful or stressed at vet visits
Storm sensitivity
Firework sensitivity
Sensitivity to loud noises
Mounting behavior
Goals & Expectations
Your thoughts about the current problem
Your expectations for change
Your goals for treatment
Under what circumstances would you consider rehoming, relinquishment, or euthanasia?
What is ONE thing you absolutely LOVE about your cat?
Feline Health History Questionnaire
Referring Veterinarian
Has your cat seen any other specialty services (e.g., neurology, internal medicine, surgery, dermatology)?
No
Yes
If yes, please list
Medications
Current medications (Include all prescription medications, supplements, heartworm prevention, and flea/tick prevention.)
Has your cat ever had an adverse reaction to a medication?
No
Yes
If yes, please explain
List behavioral medications your cat has taken in the past (if known):
General Health History
Have you noticed any changes in your cat’s eating or drinking habits in the past year?
No
Yes
If yes, please explain
Has your cat experienced any of the following in the past year?
Coughing
Sneezing
Vomiting
Diarrhea
Lumps or bumps
Pain
Limping
Other
Has your cat ever had a seizure?
No
Yes
If yes, please explain
How would you describe your cat’s typical energy level?
Very low – does not enjoy playtime; sleeps most of the day
Low – brief play periods, sleeps most of the time
Moderate – has clear awake and rest periods, plays if engaged
Moderate-high – needs at least one 45-minute play session daily; naps briefly
High – needs multiple play sessions daily; struggles to rest during the day
Any other thoughts about your cat’s personality, energy, or engagement?
Gastrointestinal (GI) History
What brand/name of food is your cat fed and how much?
List any supplements or other over-the-counter products
Any known or suspected food allergies?
Previous diets tried and any behavior or GI changes noted
Appetite
Kibble intake
Good
Moderate
Poor
Wet food intake
Good
Moderate
Poor
Treat intake
Never
Picky
Likes most
Ravenous
Human food intake
Never
Picky
Likes some
Likes most
LOVES
Licking behaviors
No excessive licking
Licks or chews furniture, carpet, or bedding
Licks or chews doors, walls, laminate, or hardwood
Excessively licks people
Excessively licks self
Non-food chewing or consumption
Does not eat non-food items
Eats small amounts of grass occasionally
Eats grass frequently but can be redirected
Eats grass frequently and is difficult to redirect
Has an intense fixation on eating grass
Consumes small parts of chews or bones
Consumes large parts of chews or bones
Consumes found or stolen objects
Does your cat eat their own feces?
No
Yes
Does your cat eat other animal’s feces?
No
Yes
Does your cat eat wild animal feces?
No
Yes
Any other licking, chewing, or eating behaviors not listed above?
Does your cat experience any vomiting or regurgitation?
No
Yes
If yes, please explain
Upper GI signs
Frequent swallowing
Difficulty swallowing
Gagging without vomiting
Excessive lip licking
Drooling
Lip smacking
Excessive burping
Other
Stool quality
Normal fecal consistency according to the Purina fecal score chart? Explain if needed.
1
2
3
4
5
6
7
Excessive flatulence?
No
Yes
Excessive belly sounds?
No
Yes
Defecation behaviors
Uses litter box
Refuses litter box
Mostly uses litter box but defecates just outside
Mostly uses litter box but defecates far away
Sniffs extensively before posturing
Walks slowly or freezes before defecating
Frenetic or frantic behavior beforehand
Circles before defecating
Becomes distracted while defecating
Vocalizes while defecating
When finished defecating, your cat typically:
Walks away
Attempts to cover
Turns around to smell feces
Immediately runs away
Remains agitated for an extended period
Skin and Ears
Excessive licking or scratching?
No
Yes
History of ear infections?
No
Yes
If yes, please explain
Pain and Mobility
Have you noticed any of the following?
Slowing down
Limping after exercise
Slow to rise from lying down
Difficulty jumping onto furniture
Stiffness
Difficulty going up or down stairs
Difficulty chasing toys or objects
Difficulty running
Avoid being touched in a particular region of the body
Restlessness or difficulty sleeping at night
Has your cat been diagnosed with pain or arthritis?
No
Yes
Has your cat been prescribed pain medication?
No
Yes
If yes, please explain
Urinary History
Does your cat typically bury urine in the litter box?
No
Yes
Has your cat ever been diagnosed with or treated for a urinary tract infection (UTI)?
No
Yes
Has your cat ever had issues with urination such as straining to urinate or blood in urine?
No
Yes
Has your cat ever been diagnosed with a urinary blockage or feline lower urinary tract disease (FLUTD)?
No
Yes
Please explain any of the above
Date of most recent urinalysis (if known)
Consent and Agreement
Client Name (printed)
*
First Name
Last Name
Client Signature
*
Date
*
-
Month
-
Day
Year
Date
How did you hear about us?
Primary Care Veterinarian
Trainer
Internet
Social Media
Other
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