Behavior Questionnaire 1 Step 1For pricing and consult details, visit the Behavior Consulting page***Please Note: Due to an overwhelming response to this service, it may be 3-4 weeks before your consultation.***Owner InformationFirst Nameno-iconLast Nameno-iconAddressno-iconno-iconCityno-iconStateno-iconZip Codeno-iconCell Phone0 / Alternate Phone0 / EmailemailPet InformationNameno-iconBreedno-iconDate of Birthdate_rangeAgeno-iconSexFemaleMaleNeutered/SpayedYesNoIs your cat declawed?YesNoWhich paws?Front OnlyAll FourWere there complications from the surgery?(i.e. infection)0 / Does your cat go outdoors?YesNoWhat percentage of the time does your cat spend outdoors?no-iconIs access limited?(i.e. leash, cat door, balconey/deck)no-iconDo any of your other cats have access to the outdoors?YesNoWhat brand of food does your cat currently eat?no-iconWhat type of food do you feed?DryCannedBothHow do you feed your cat?(i.e. food out all the time, meals, timed feeder, etc.)0 / What is your cat's favorite treat?no-iconGeneral InformationWho referred you to us?no-iconWho is your regular veterinarian?no-iconClinic nameno-iconClinic Addressno-iconno-iconCityno-iconStateno-iconZip Codeno-iconClinic Phone Numberno-iconMay we contact them for your records?Yes NoHave you visited this veterinarian for this problem?no-iconCat's BackgroundWhy did you decide to get a cat?0 / Why this particular breed, sex, color?0 / How old was the cat when it was acquired?no-iconWhere did you get this cat?(i.e. SPCA, Humane Society, Pet Store, Breeder, Friend, Stray, Gift, etc.)no-iconIf known, describe your cat's behavior as a kitten0 / Has your cat had other owners?Yes NoDon't knowDo you know how many?no-iconWhy was the cat given up?0 / How Long have you had this cat?no-iconBehavior ProblemWhat is your main behavior problem or complaint?0 / When did this problem start?0 / Do you recall anything specific at the onset of the behavior problem?(i.e. moving, birth of a child, houseguests, construction, parties, etc.)0 / How frequently does the problem (or problems ) occur?0 / Has the problem changed in frequency or intensity?0 / What have you done so far to correct the problem?0 / How do you discipline your cat for this problem?0 / Rate this problem on a scale of 1-10(10 being the worst)12345678910Are there any secondary problems or concerns?0 / Elimination BehaviorHow often does your cat use the litter box?OccasionallyNeverOnly urinatesOnly defecatesAlwaysIf your cat does not consistently use the litter box, where in the house are they eliminating?0 / How many times a day does your cat urinate? Describe the size of the urine clumps.0 / How many times a day does your cat defecate? Describe the stools.(size of fecal balls, amount, firm, soft, formed, runny, etc.)0 / How many litter boxes do you have?0030How many different litter box locations do you have?0 / Do you have a commercial litter boxes?YesNoHow many commercial litter boxes?no-iconDo you have commercial litter boxes with removable “lip”YesNoHow many commercial litter boxes with removable “lip”?no-iconDo you have covered boxes, “cave”-type front door?YesNoHow many covered boxes, “cave”-type front doorno-iconDo you have covered boxes, “Booda” type (cat crawls into hole)?YesNoHow many covered boxes, “Booda” type (cat crawls into hole)?no-iconDo you have automatic litter boxes (i.e. Littermaid)?YesNoHow many automatic litter boxes (i.e. Littermaid)?no-iconDo you have any other types of litter boxes?YesNoCan you describe the other litter boxes you have and how many of each?0 / How old is each litter box?0 / Where are the litter boxes?0 / Do you have a pet door leading to the litter box area?0 / What type of liners do you use?0 / How often do you scoop the litter box?0 / How often do you completely empty and scrub the box clean?0 / What type of cleaning products do you use?If they have a scent, please describe the scent (i.e. lemon, citrus, vanilla, etc.)0 / Do you refill it with clean litter?0 / What brand of litter do you use?0 / How long have you been using this brand?0 / What other brands have you tried?no-iconDo you change brands often?YesNoWhat type of litter?(Check all that apply)Scoopable/ClumpingNon-scoopable (clay)ScentedUnscentedCrystalPineOtherIf Other, please describe0 / You said you use a non-scoopable litter, do you scoop out urine or mix it in with the remaining litter?Scoop out urineMix it in with remaining litterHow do you clean/scoop/maintain the box with the non-scoopable litter?0 / Does your cat dig in the litter before eliminating?no-iconDoes your cat cover urine and feces in the litter box?no-iconDoes you cat squat, stand or perch on the edge of the box when eliminating?no-iconDo you add deodorizers to the box?(i.e. baking soda)no-iconDo you have a litter step out matt, other tray or newspapers around the litter boxes?Please describe the type of matt you have0 / Home EnvironmentPlease list all people, including you, living in the household include ages and their relationship/role in caring for the cat0 / Please list all animals in the household, include ages, breeds and any information you feel may be relevant0 / Please describe your cat’s relationship to the other animals(i.e. friendly, hostile or fearful)0 / Have you moved since acquiring your cat?YesNoHow many times?no-iconWhere does your cat sleep at night?0 / Do you have any areas if your home that are off limits to the cat(s)?YesNoWhere? Why? Have they always been off limits?0 / Are they allowed in these areas some of the time and not others?0 / Social BehaviorWhere is your cat when alone in the house?0 / How does your cat behave when you return home?0 / Where is your cat when you have guests?0 / How does your cat behave with adult visitors?0 / How does your cat react to visiting children?0 / How does your cat respond to other cats seen out of the window or in the yard?0 / How does your cat behave at the veterinarian?0 / How would you describe your cat’s overall personality?0 / When does your cat hiss or growl?0 / Does your cat bite you?YesNoWhat are you doing when this happens?0 / Does your cat scratch you?YesNoWhat are you doing when this happens?0 / Does your cat vocalize?YesNoDoes it happen excessively? At what time of the day?0 / Play BehaviorWhat is your cats overall activity level?0 / What toys does your cat prefer?0 / Does your cat carry toys/objects around the house or “mother” other animals or objects?0 / Does your cat chew/suckle/lick strange objects or clothing?0 / How do you play with your cat?0 / Does your cat have a favorite scratching post or scratching area?YesNoPlease describe the post or area.Include height, substrate and location0 / Do you have cat trees?YesNoPlease describe the type of condos, where they are located and if your cats use them0 / Do you trim you cat’s nails?0 / Does your cat scratch on anything you wish he/she would not?0 / Sexual BehaviorAt what age was your cat spayed or neutered?0 / Were there any complications with the surgery?0 / Were there any behavior changes after the surgery?0 / Does your cat mount other cats, objects or people?0 / Does your cat vocalize, flag her tail (whipping from side to side) or tread (make biscuits) with her back feet?0 / Has he/she ever been bred?0 / Are you planning to breed your cat in the future?0 / Grooming BehaviorDoes your cat groom, lick or bite himself excessively?no-iconDoes your cat have bald patches?YesNoWhere are they located?0 / Does your cat’s skin ripple or twitch?YesNoDoes this happen after petting or without being touched at all?0 / Does your cat chew or suckle its tail?0 / Would you say your cat is a good groomer?(i.e. coat is well maintained without you having to brush or bathe it)0 / Daily RoutineHave there been any changes in your routine lately?0 / Have any recent activities been stressful to your cat?(i.e. parties or construction)0 / Who feeds your cat? Where are the food bowls located in the home?0 / Where does your cat drink?0 / Do you find he/she drinks excessively?0 / Do you find your cat has difficulty navigating the household?(i.e. jumping on the bed, climbing the stairs, tend to stay in one location/one floor, etc.)0 / Is your cat currently on any medication?0 / Has your cat been on medications in the past?YesNoPlease list the medication, dosage and what it was prescribed for0 / If this problem continues, I will:Ignore ItContinue to seek help and work on the problemGive my cat awayPut my cat outsideEuthanize my catHome VideoPlease provide a brief video of your home. Please be sure to include the following: location of litter boxes, food, water, cat trees, scratching posts, points of conflict and locations where elimination outside the box has occurred if applicable. This video does not need to be hi-tech. The purpose is to assess the environmental resources currently provided so suggestions can be made to help improve upon what is being offered. If unable to upload the video here it can be sent in a separate email. cloud_uploadUpload your home videoLegal StuffBy submitting this questionnaire, I understand that the behavioral recommendations given by Fundamentally Feline are in no way a substitute for veterinary care.I understand that the success of a behavior modification plan depends upon my compliance with the instructions given and that not all behavior problems can be solved, especially long-term ones, and in some cases, only an improvement in the behavior may be the best outcome.I release Fundamentally Feline from any and all liability in regard to health and behavior of my pets, the safety of all people in the household who interact with the cat, damage or loss to my property and in regard to any aspect of the advice given.I understand that payment is due in full at the time of service.Submit your answers keyboard_arrow_leftPrevious Nextkeyboard_arrow_right
