Hippocampus Online LYF Mentorship Cat Consultation Feline History

Hippocampus Online Cat Calls

Feline Behavior History Form
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I agree to allow members of the "Land on Your Feet (LYF) Cat Behavior Consultant Mentorship" to review this history form for educational purposes.*

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About This Cat's Legal Owner
Name*
Email*
example@example.com
Where does this cat currently live*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
About This Cat

(if more than one cat is involved, describe primary cat)
Cat's Name*
Breed or mix (if known)*
Current Age*
Sex*

Neutered MaleMaleSpayed FemaleFemale
Declawed*

NoFront onlyAll 4 paws
Where did you get this cat?*
How old was cat when you acquired him/her? *

Wee baby (under 8 weeks)kitten (8-12wks)Juvenile (3 mos - 6mos)Adolescent (6mos -1yrs)Young Adult (1-3yrs)Adult (3-8yrs)Senior (8-12 yrs)Geriatric (12+yrs)
Describe what you know about this cat's history?*
How long has this cat lived with you?*
Concerning Behaviors
Most concerning behavior*
Other concerning behavior?
Additional concerning behavior?
How do you typically reward good behavior? (check all that apply)*
How do you typically punish/correct unwanted behavior? (check all that apply)*
Health/Nutrition
Date of most recent exam*
What occurred during the exam? (check all that apply)
Lifestyle

Describe all HUMANS in this cat's life*

	First name	Age	Pronouns	Relationship (love, tolerates, dislikes, other)	Contact(live together, visits), other
1
2
3
4
5

Describe all ANIMALS in this cat's life*

	Name	Age	Cat, dog breed, other?	Relationship (ex: Love, tolerate, dislike, other)	Contact (live together, visits, other)
1
2
3
4
5

Cat's typical exercise on an average day*
What is your cat's preferred play activity?*

Chases/ambushes other petsWrestles other petsRaces around the house on their own/wheelBags/hidey spot "surprise"Chases toys by themselfChases toys humans throwFlirt toys with humansWrestles with human (hands/feet)Robot/battery operated toysChase/huntStalk/pounceBite/mouthWrestle/paws/grabOther
Does cat go outside?

NeverAt scheduled timesIn/out by choiceOnly when supervisedOther

What does your cat have access to? (check all that apply)*

	None	one	Multiple in one room	Multiple throughout home
scratcher
cat tree
litter box
Water fountain
enclosed deck/porch/catio
Food puzzle(s)

Have you discussed any behavior concerns with your vet? What advice did they give, if any?
List any current or past injuries or illnesses*
List any medications, supplements, etc. (including dosage)*
Please provide any relevant vet records, such as test results

Upload a File

Cancelof

Describe feeding*

	Dry/kibble	Canned/pouch	Homemade	Raw
NA
Free choice
Scheduled
Via puzzle toy

What brand(s) of food do you feed?
List any food sensitivities or allergies*
Cat-Cat Conflict
Is this cat having issues with another cat?*

YesNo
Describe the other cat involved
Describe the current living situation
Additional details about the conflict
List any other cats the primary cat has conflict with
Litter Box Details
Is your cat eliminating outside of the box*

YesNo
WHERE in the home is the urine occurring?
What materials is cat URINATING on?
How would you describe the urination?

Large puddles on flat or horizontal surfaceSmall puddles on flat or horizontal surfaceOn vertical surfaces, ex: walls, windows, etc.Dark in color, smells funny or strong, etc.Dark orange or rusty brownTinged pinkLittle to no colorOther
WHERE in your home is the feces occurring?
What materials is cat DEFECATING on?
How would you describe the defecation?

1. Very hard and dry, often expelled as individual pellets, requires much effort to expel from the body, leaves no surface residue when picked up.2. ∙ Firm, but not hard, pliable, Segmented in appearance, Little or no residue on ground when picked up3. Log shaped, moist surface, Little or no visible segmentation, Leaves residue on ground, but holds form when picked up4. Very moist and soggy, Log shaped, Leaves residue on ground and loses form when picked up5. Very moist but has a distinct shape, Present in piles rather than logs, Leaves residue on ground and loses form when picked up6. anything softer/looser than aboveUnknown

How often do you scoop?

Multiple times per dayOnce dailyA few times a weekWeeklyOther
Aggression
Is your cat displaying aggression toward humans?*

YesNo

Describe all victims

	Name & age	Human, cat, other?	Live together, guest, other?
Victim 1
Victim 2
Victim 3
Victim 4

What types of injuries have occurred? (check all that are relevant)
Provide any additional information, victims, injuries, or incidents
Is there anything else you'd like to add?
Scheduling

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Donation

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payment info*
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Should be Empty:

	Location in home	Dimensions	Style (covered, top entry, auto, brand if any, etc)	Type of litter
Box 1
Box 2
Box 3
Box 4

	Brand	Scented?	Material (Clay, corn, paper, etc)	Regularly try new kinds
In box 1
In box 2
In box 3
In box 4

Hippocampus Online Cat Calls