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Cat Behavior History Form

Cat Behavior History Form

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Client Name*

Cat Name

Breed/Sex/Age

Veterinarian

If other specify

When?

For what purpose was this cat obtained?

Companionship breeding show other

If other please specify

Rate your experience level with cats

Novice Moderate High

Describe the cat's personality:

Date of last veterinarian exam

List all major surgical or medical problems and approximate dates:

List all medications (including dosage and schedule) currently being taken by this cat:

PRINCIPAL COMPLAINT:

Describe the primary problem and how it developed. Including where and under what circumstances was each problem(s) first noted and the situations(s) in which the problem is most likely to occur?

The severity is

mild moderate severe other

If other

What age was the cat when this problem started?

Month and year problem started?

How many times has the problem occurred

a) past week

b) past month

c) past year?

Describe any change in frequency or appearance:

The problems occur:

When the cat is left alone

Always Usually Rarely Never

In the presence of the family members

Always Usually Rarely Never

During the night when the family sleeps

Always Usually Rarely Never

When guest comes over

Always Usually Rarely Never

List all medications (dosage, schedule & duration) that has been prescribed for a behavior problem and the results:

Have you considered euthanasia? Y. N. Comment:

Environment/Lifestyle

Briefly describe home: apartment, house, other:

Describe where cat stays at each of the following times:

Family home:

Family away:

Family asleep:

When guests visit:

Favorite resting/sleeping area(s):

List each family member (including daily schedule, sex, and age if under 18):

1. M/F Age______ Schedule

2. M/F Age______ Schedule

3. M/F Age______ Schedule

4. M/F Age______ Schedule

5. M/F Age______ Schedule

6. M/F Age______ Schedule

How long is the cat home alone on the average day?

Cat’s reaction when left alone?

List other animals in the home 1:

Name / Species / Breed

Sex

Male Female

Age Now

Age when obtained

Order obtained

List other animals in the home 2:

Name / Species / Breed

Sex

Male Female

Age Now

Age when obtained

Order obtained

List other animals in the home 3:

Name / Species / Breed

Sex

Male Female

Age Now

Age when obtained

Order obtained

Describe how your pets interact with each other, including who’s in charge.

Have there ever been any changes in the household that your cat had difficulty adapting to? Describe:

Does this cat get along with other animals? Y[ ] N[ ] If not, explain:

How does this cat react to unfamiliar people?

Diet

___% Dry (Brand____________________) ______%

__% Table Scraps, Supplements: ________________________________________________

How many times a day is the cat fed? ____________________

By whom? ______________________________

When? ___________________________

Location: _________________________

Does your cat finish his/her meal(s)? __________%

Leftover _________________________

Describe feeding habits:

poor eater picky normal appetite voracious

What is your cat’s favorite treat(s)?

When are treats delivered?

Activity

At what time of the day is the cat most active?: ______________

Time indoors ____ %

Time outdoors ____ %

When outdoors is the cat supervised? Y. N. If yes, describe: (off lead, on harness, etc)

Does your cat run free? Y. N. When/where/how long?

What is the cat’s favorite activity?

Does the cat play with toys?

How often day week month

With people?

Other cats?

Favorite Toys?

How does your cat respond to catnip?

Describe the cat’s grooming

frequent very little excessive other

If other

Are there any situations that cause grooming to increase? Describe.

Does the cat have a scratching post? Y. N. If yes, describe size, shape, location:

Does the cat scratch any areas/objects other than its scratching post? Y. N. Describe locations/type of surfaces preferred:

Does the cat kneed? If so, what objects?

Handling How does the cat react to:

Nail trimming:

Giving medication:

Cleaning ears:

Grooming

Bathing:

Patting head:

Rubbing tummy:

Lifting:

Rolling over:

Social behavior : Describe cat’s reaction to:

Familiar cats:

Unfamiliar cats:

Familiar people:

Unfamiliar people:

Training: Describe any training?

What commands does your cat respond to?

The cat’s ability to learn is fast/slow/easily distracted, other

Punishment

Have you used any of the correction techniques:

Physical (hitting)

Yes No

Success

High Med Low None

Noise (Shaker can/siren)

Yes No

Success

High Med Low None

Ultrasonic (CatAgree)

Yes No

Success

High Med Low None

Water spray

Yes No

Success

High Med Low None

Verbal/shouting

Yes No

Success

High Med Low None

Time Out

Yes No

Success

High Med Low None

E-Collar

Yes No

Success

High Med Low None

Other

Yes No

Success

High Med Low None

Has any punishment made the problem worse or caused aggression?

Fears and Phobias

Describe any situations where your cat is shy, timid, or fearful.

How does the cat react when frightened? Cower, retreat, aggression, other:

Elimination Data

Where does your cat eliminate? ______ % Indoors ______ % Outdoors

How often is the litter box cleaned?

Changed?

How many litter boxes do you have?

Is there a type of litter the cat strongly likes or dislikes? Describe:

Is there a type of litter box the cat strongly likes or dislikes? Describe:

Are there litter box locations that the cat strongly likes or dislikes? Describe:

Do the cat’s use each other’s litter boxes? Y N Comment:

Does your cat dig/bury after eliminating? Y N Comment:

Feline Elimination Problems (complete only if applicable)

Litter box information 1:

Location

Type of litter

Duration of use

Litter box information 2:

Location

Type of litter

Duration of use

Litter box information 3:

Location

Type of litter

Duration of use

Has this cat ever eliminated consistently in the litter box?

Yes No

When/how long?

Age when litter trained

Method of training

Any problems training?

When does the elimination problem occur?

family not home family home but not supervising family sleeping/nighttime with family watching

What percent of all inappropriate elimination is urine? __% stool? %

Add text here

Frequency of urination outside the litter box each ____day, ____week ____ month.

Never urinates in box

Yes No

Frequency of defecation outside the box each: ____ day, ____ week ____ month.

Never defecates in box

Yes No

Is there a preference for secluded areas? (closets, under furniture, etc.)?

Yes No

Is there a preference for urinating on:

Upright surfaces(walls, sides of furniture, drapes)

Yes No

____ % upright

Horizontal surfaces(floor, top of counters or furniture)

Yes No

______% horizontal

Is there a particular room or area where the cat prefers to soil?

Are there rooms or areas where the cat never soils, even though it has access to the areas?

Surface preference for soiling:

Are there any surfaces on which your cat will not eliminate?

Object preference for soiling (your belongings, new furniture, old furniture etc)?

List the most frequently soiled areas, type of surface (carpet, bedspread, furniture, etc) and how often your cat eliminates in each inappropriate location.

Location

Surface or object

How often

% of total soiling

Location

Surface or object

How often

% of total soiling

Location

Surface or object

How often

% of total soiling

Location

Surface or object

How often

% of total soiling

Location

Surface or object

How often

% of total soiling

Comments:

Do other cats visit or mark outside your windows, doors, etc?

Yes No

If yes, does the cat’s elimination occur near these doors, windows, etc?

Has your cat ever had a urinary problem? Yes/No If yes, describe and indicate when:

Any treatment?

Current treatment (medication/diet)?

Has your cat ever had a urinalysis?

Yes No

If yes, indicate when and outcome:

Does any straining or pain accompany urination?

Yes No

Defecation?

Yes No

Describe:

Any blood in the urine?

Yes No

Stool?

Yes No

Describe

Are stools regular and normal consistency?

Yes No

If no, describe:

Is there an increasing in drinking?

Yes No

Describe:

# of urinations/day?

# defecations?

Is there increased frequency of urination?

Yes No

Defecation

Yes No

Comments:

AGGRESSION DATA (complete only if applicable)

Has the cat ever bitten or scratched aggressively and broken skin or caused injury?

Yes No

Describe:

Is the cat aggressive to family members?

Yes No

Describe:

Is the cat aggressive to non-family members?

Yes No

Describe:

Do any circumstances cause aggression (growl, glare snarl, hiss, snap, bite)? For example, approach when eating, chewing toy, disturbed when resting, punishment/discipline, people/animals entering home/yard:

Is there a particular type of handling (lifting, patting, grooming, trimming nails, cleaning ears, brushing teeth, giving medication, other) that leads to aggression?

Is there an area of the body that is particularly sensitive?

Describe any other situations, not previously discussed where the cat has been aggressive:

Is there a particular person or type of person (baby, children, etc) that the cat is aggressive toward?

When your cat was aggressive, was there an illness, injury, or unusual situation that might have caused the aggression?

Is your cat aggressive with other cats?

Yes No

Describe

Does your cat show fear at the time of aggression? (growling, snapping, biting accompanied by cowering, ears back, tail tucked, hackles raised, retreating, hiding) Describe:

If Other

Please do not submit any Protected Health Information (PHI).

DJG Animal Behavior Services

Office Hours

Monday

9:00 AM - 5:00 PM

Tuesday

9:00 AM - 5:00 PM

Wednesday

9:00 AM - 5:00 PM

Thursday

9:00 AM - 5:00 PM

Friday

9:00 AM - 4:00 PM

Saturday

Closed

Sunday

Closed

Terms and Conditions: Payment is necessary to secure an appointment. There is a $50 USD re-scheduling fee and $150 USD cancellation fee. Full service charge applies to changes < 48 business hours of the scheduled appointment.