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
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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.
Has your cat seen any specialty veterinary services such as dermatology, internal medicine, neurology, etc? If yes, please list
Back
Next
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
Back
Next
Feline Health History Questionnaire
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):
Gastrointestinal (GI) History
What brand/name of food is your cat fed and how much?
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
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
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
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) or other urinary tract disorders?
No
Yes
Has your cat ever had issues with urination such as straining to urinate or blood in urine?
No
Yes
Please explain any of the above
Date of most recent urinalysis (if known)
Back
Next
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 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)
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
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
Back
Next
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
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
Typical Daytime Routine
Is your cat allowed outdoors?
No
Yes
If yes, how is access controlled?
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
Back
Next
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
Back
Next
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
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
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
Back
Next
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?
Back
Next
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
Submit Questionnaire
Submit Questionnaire
Should be Empty: