Cat Client History

Cat Client History

Cats affect each other's behavior. Please fill out a form for each cat, even it that cat has no problem. I will respond to forms during business hours, which are usually Monday -- Friday, 8:00am. - 5:00pm.
Owner's Full Name*

First NameLast Name
E-mail address that you check at least daily.*
example@example.com
Alternate E-mail address, if you'd like.
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Can you guarantee free parking in front of your home?*

YesNoN/A I'm having a virtual consultation
If I am not parking in your driveway on the same street as your address, please explain the parking situation.
Is there at least one room in your home that has an interior door, and is NOT a bathroom?

Yes.No.
How did you hear of me? (Check all that apply).*

Internet CommercialFacebookGoogle searchVeterinarianBing searchAngie's ListAnimal shelterFriendIAABC DirectoryRepeat clientAnother behavior consultantOther
Describe the problem behavior (Type N/A if this cat is not the one you are seeking help for.)*
Date it began?*
How often does it occur?*

Multiple times a dayDailyMultiple times a weekWeeklyA few times a monthRandomlyOnly in specific situations
What is your definition of success regarding this problem behavior?*
When are you normally available for a consultation? (Select all that apply).*

Monday morningsMonday afternoonsTuesday morningsTuesday afternoonsWednesday morningsWednesday afternoonsThursday morningsThursday afternoonsFriday morningsFriday afternoons (between 12:00pm and 1:00pm)Zoom consultation starting between 9:00am and 4:00pm ETZoom consultation starting between 4:30 and 5:00pm ETHighly variable schedule
I would like a written report. (For detail see https://patienceforcats.com/cat-behavior-services/ )*

YesNo
Cat's name*
Cat's date of birth (approximate)*
Cat's breed (if unknown type DSH for Domestic Short-hair or DLH for Domestic Long-hair)*
Cat's color or pattern*
Cat's sex*

Neutered maleSpayed femaleMale (not neutered)Female (not spayed)
Cat's weight*

Less than 5 lbs.5 to 9 lbs.10 to 14 lbs.Over 14 lbs.
From where did you obtain this cat?*
Age of cat when you obtained him/her*
Date you adopted your cat*
If neutered/spayed, at what age?*
Declawed?*

YesNo
If declawed, at what age?
Previously owned?*

YesNoPreviously strayDo not know
Currently*

Indoor onlyOutdoor onlyIndoor/outdoor
This cat previously lived*

Indoor onlyOutdoor onlyIndoor/outdoorDo not know
Has this cat ever lived with other cats after being weaned?*

YesNoDo not know
Any past behavioral issues, that are now resolved?*

Unreliable litter box useScratching furniture or rugsAggressionAnxietyOtherDo not knowNone
What, if anything, do you know about this cat's history before he/she came to live with you?
What is this cat's personality like? Check all that apply.*

Friendly to everyone, even strangersFriendly to people he/she knows wellFriendly to just one personActivePlayfulIndependentFearfulConfidentAggressiveBossyShyNeedy/Clingy
Check all that this cat tolerates:*

Claw trimmingBrushing or combingGetting a pillGetting petted on the headGetting petted on the backGetting petted on the flanksGetting picked upNone of the above
What does this cat like for a treat?*

CatnipHuman-grade meatGreeniesFreeze-dried liverOther commercial treatsBaby foodOtherDoes not like treats
Which of the following does this cat find very enjoyable? (check all that apply.)*

TreatsCuddlingPettingInteractive play with a personPlaying with another catPlaying with a dogSolo play with a toyNone of the above
How often does this cat play?*

DailyWeeklySeldomNever
How many rooms in your house does the cat have access to?*

12most of the roomsall of the rooms
Do you have different groups of cats kept separate from each other?*

Yes.No.Occasionally, when I foster/pet sit
What do you feed this cat for meals? (check all that apply)*

Dry cat foodCanned cat foodTable foodDry and canned foodRawOther
What brand(s) of food do you use?*
How often do you feed?*

Once a dayTwice a dayThree times a day or moreFood is always availableRandomly
Where do you feed this cat?*
Are other cats/dogs present when this cat is fed?*

YesNoDo not knowSometimes
How many scratching posts (vertical) do you have?*

NoneOneTwoMore than two
How many scratching pads (horizontal or inclined) do you have?*

NoneOneTwoMore than two
List all of the rooms that have a scratching post*
List all of the rooms that have a scratching pad*
Does your cat scratch the furniture or rugs?*

NoRarelyNot any moreSometimesAt least once a weekDaily
How many litter boxes do you have?*
What litter do you use?*
Where are the litter boxes located?*
Does this cat urinate outside the litter box in the home?*

NoRarelyNot any moreSometimesAt least once a weekDaily
Does this cat defecate outside the litter box in the home?*

NoRarelyNot any moreSometimesAt least once a weekDaily
Name all of the people living with the cat, or regularly spending at least one day a week in the home. List their relationship to you. For children please list their age. Please state whether each person's relationship with this cat (including yours) is good, bad, or neutral.*
Name all of the other pets living in the home, or visiting regularly. Include their species, age, sex, and whether their relationship with this cat is good, bad, or neutral.*
Have any of the following changes occurred in the past year?*

Moved houseNew furniture or additionPerson moved inPerson moved outAnother pet moved out or passed awayA new pet moved inNone
Veterinarian*
Veterinarian's phone number

Area CodePhone Number
When was this cat's last veterinary visit?*
What was the result of this veterinary visit?*
Please list type and dosage of any medication this cat is currently on.
Does the cat currently have any of the following illnesses?*

DiabetesHyperthyroidismKidney diseaseLower urinary tract diseaseDiarrheaArthritisObesityNone of the aboveOther
If you picked "other" above, please explain.
Has this cat ever been injured?*

YesNoDo not know
If yes for above, please explain.
If there are any other previous health problems that are now resolved, please list them.
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