Alex's Feline Training and Behavior Consulting
New Client Form - Behavior Please allow as much time as needed to fill out this form with as much details as possible.
Today's Date
-
Month
-
Day
Year
Date Picker Icon
Your Name
*
First Name
Last Name
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Vet's Name or Practice Name
*
Vet's Phone Number
*
-
Area Code
Phone Number
Last vet appointment
*
-
Month
-
Day
Year
Date Picker Icon
Please list all the animals in the household, their age, in the order in which they were obtained
*
Name of the pets that you are contacting me about
Sex
*
Intact Male
Neutered Male
Intact Female
Spayed Female
Are you the primary caregiver for your cat?
Yes
Yes with my spouse\significant other
Yes with the whole family
No, my spouse\significant other is
No, someone else in the home
Is this your first cat?
Yes
No
Where did you acquire your cat from and how old was the cat?
Any behavior history given before you took in this cat?
No
What and when do you feed your cat? (check all that apply)
Dry food only, left out 24/7
Dry food only, meals divided throughout day
Dry food left out and wet food once a day
Dry food left out and wet food twice a day
Dry food, meals divided, wet food once a week
Wet Food only, twice a day
Homemade wet food\Raw diet
Treats
Table scraps
Is your cat declawed?
No
Yes
Please list any medications, including flea prevention, vitamins, calming spray, etc., that your cat is currently taking
Any other medical history that I should know about?
What is the current behavior issue? (Please check all that apply)
*
Inappropriate scratching
Inappropriate elimination and\or spraying
Aggression with another person or animal
Keeping me up at night
Extremely shy or timid
Boredom
Moving or traveling and would like more information to help my cat with the process
How long has this been going on?
*
Please describe the three most recent andor most severe occurrences of this behavior:
*
Can you predict when this behavior will happen?
No
What have you done so far to try and correct the problem? (check all that apply)
*
Locking in separate room
Spankings or taps on the nose
If soiling, rubbing nose in mess
Crating
Squirt bottles
Verbal scolding
Clapping hands
Making a loud noise
Nothing
How did the cat respond?
*
How often do you play with your cat?
Daily
Every other day
Weekly
Monthly
When I can
Other than this current behavior issue, would you consider your cats' daily activities as normal?
*
Yes
Have there been any changes to your usual schedule or to your home? (check all that apply)
*
No
Yes, to my schedule
Yes, to another household members' schedule
Yes, moved to new apartment or home
Yes, renovated or added new furniture
Yes, new family member
Yes, new pet
Started volunteering with an organization that works with animals
Started fostering animals at my home
Does your cat go outside?
*
Indoor only
Indoor and outdoor
If your cat is indoors only, is there any visual or physical access to and from the outdoors?
Please answer the following questions if you cat has outdoor access:
Where to they enter and exit?
How long does each cat stay outside?
How do you get them back inside?
Tell me about your neighborhood:
For scratching issues, please answer the following questions:
Please describe where your cat is currently scratching?
What happens immediately before AND after your cat scratches?
How often do you trim your cats nails?
Weekly, front only
Weekly, back only
Weekly, both front and back
Monthly
As needed (either by you, groomer, or vet staff)
Never
Would you be interested in learning how to trim your cats nails at home?
Yes
No
For elimination\litter box issues, please answer the following questions:
Have you made an appointment with your veterinarian for this issue?
*
No
Please check all that apply:
Urine only outside of box
Feces only outside of box
Both urine and feces outside of box
Urine on walls and\or other vertical surfaces
Urine as puddles on floor
When did your cat start to eliminate outside the box?
Does your cat still use the litterbox?
Yes
No
Unsure\Unknown
Please list the specific locations, objects or materials outside the box on which your cat will eliminate on (such as "only on the couch in the living room" or "kitchen cabinet next to sink".)
How often does your cat eliminate outside the box? (check all that apply)
Multiple times per day
Once or twice per day
Once or twice per week
Multiple times per month
Every few months
Seems to be random
Unknown or uncertain
If your cat urinates outside the box, have you ever witnessed it? If so, please describe your cat's posture (such as standing or squatting, tail erect or down and to the side, etc.)
What products do you use to clean areas where your cat has soiled?
How many boxes are in your house?
Where are the litter boxes located?
How often are the boxes scooped?
Twice a day
Once a day
Once every other day
Once every three days
Once a week
How often do you dump the litter and clean the boxes?
Once a week
Once a month
Twice a year
Once a year
What chemicals or products are used to clean the boxes?
Do you use (check all that apply):
Covered boxes
Liners
Baking soda or other neutralizers
Motorized or self-scooping litter boxes
Please attach a rough sketch of your home and mark the locations of all litterboxes, all windows and doors to outside, food and water bowls, all major appliances (such as washer, dryer) and each location of spraying, peeing, and pooping outside of the box
For aggression issues, please answer the following questions:
At what age or when did your cat become aggressive towards another person or pet?
Please describe what your cats does immediately before AND after an aggressive event?
Has there been any changes to your home when you first noticed the aggression?
If you have other pets, what are they (such as dog, cat, potbelly pig) and how long have they been in the home? Please include if there is a specific person or pet that your cat will predictably go after:
Has a new family member be added to your household?
No
What is the frequency of this conditionbehavior? (check all that apply)
Multiple times per day
Once or twice per day
Once or twice per week
Multiple times per month
Every few months
Seems to be random
Unknown\Uncertain
If your cat has shown aggression to you, another person, andor another animal, did it require medical or veterinary attention?
No
What have you done to try to correct this behavior (please check all that apply):
Locking in separate room
Spankings or taps on the nose
Crating
Squirt bottles
Verbal scolding
Clapping hands
Making a loud noise
Nothing
If this behavior isn't corrected, would you rehome or euthanize your cat?
*
No
Yes, I'll rehome
Yes, I'll euthanize
Enter the message as it's shown
*
Submit
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm