Behavior Questionnaire

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1 Step 1

For 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 Information

First Name

Last Name

Address

City

State

Zip Code

Cell Phone

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Alternate Phone

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Pet Information

Name

Breed

Date of Birth

Age

Sex

FemaleMale

Neutered/Spayed

YesNo

Is your cat declawed?

YesNo

Which paws?

Front OnlyAll Four

Were there complications from the surgery?(i.e. infection)

0 /

Does your cat go outdoors?

YesNo

What percentage of the time does your cat spend outdoors?

Is access limited?(i.e. leash, cat door, balconey/deck)

Do any of your other cats have access to the outdoors?

YesNo

What brand of food does your cat currently eat?

What type of food do you feed?

DryCannedBoth

How do you feed your cat?(i.e. food out all the time, meals, timed feeder, etc.)

0 /

What is your cat's favorite treat?

General Information

Who referred you to us?

Who is your regular veterinarian?

Clinic name

Clinic Address

City

State

Zip Code

Clinic Phone Number

May we contact them for your records?

Yes No

Have you visited this veterinarian for this problem?

Cat's Background

Why did you decide to get a cat?

0 /

Why this particular breed, sex, color?

0 /

How old was the cat when it was acquired?

Where did you get this cat?(i.e. SPCA, Humane Society, Pet Store, Breeder, Friend, Stray, Gift, etc.)

If known, describe your cat's behavior as a kitten

0 /

Has your cat had other owners?

Yes NoDon't know

Do you know how many?

Why was the cat given up?

0 /

How Long have you had this cat?

Behavior Problem

What 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 /

Are there any secondary problems or concerns?

0 /

Elimination Behavior

If 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?

030

How many different litter box locations do you have?

0 /

Do you have a commercial litter boxes?

YesNo

How many commercial litter boxes?

Do you have commercial litter boxes with removable “lip”

YesNo

How many commercial litter boxes with removable “lip”?

Do you have covered boxes, “cave”-type front door?

YesNo

How many covered boxes, “cave”-type front door

Do you have covered boxes, “Booda” type (cat crawls into hole)?

YesNo

How many covered boxes, “Booda” type (cat crawls into hole)?

Do you have automatic litter boxes (i.e. Littermaid)?

YesNo

How many automatic litter boxes (i.e. Littermaid)?

Do you have any other types of litter boxes?

YesNo

Can 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?

Do you change brands often?

YesNo

If Other, please describe

0 /

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 litter

How do you clean/scoop/maintain the box with the non-scoopable litter?

0 /

Does your cat dig in the litter before eliminating?

Does your cat cover urine and feces in the litter box?

Does you cat squat, stand or perch on the edge of the box when eliminating?

Do you add deodorizers to the box?(i.e. baking soda)

Do you have a litter step out matt, other tray or newspapers around the litter boxes?Please describe the type of matt you have

0 /

Home Environment

Please list all people, including you, living in the household include ages and their relationship/role in caring for the cat

0 /

Please list all animals in the household, include ages, breeds and any information you feel may be relevant

0 /

Please describe your cat’s relationship to the other animals(i.e. friendly, hostile or fearful)

0 /

Have you moved since acquiring your cat?

YesNo

How many times?

Where does your cat sleep at night?

0 /

Do you have any areas if your home that are off limits to the cat(s)?

YesNo

Where? Why? Have they always been off limits?

0 /

Are they allowed in these areas some of the time and not others?

0 /

Social Behavior

Where 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?

YesNo

What are you doing when this happens?

0 /

Does your cat scratch you?

YesNo

What are you doing when this happens?

0 /

Does your cat vocalize?

YesNo

Does it happen excessively? At what time of the day?

0 /

Play Behavior

What 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?

YesNo

Please describe the post or area.Include height, substrate and location

0 /

Do you have cat trees?

YesNo

Please describe the type of condos, where they are located and if your cats use them

0 /

Do you trim you cat’s nails?

0 /

Does your cat scratch on anything you wish he/she would not?

0 /

Sexual Behavior

At 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 Behavior

Does your cat groom, lick or bite himself excessively?

Does your cat have bald patches?

YesNo

Where are they located?

0 /

Does your cat’s skin ripple or twitch?

YesNo

Does 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 Routine

Have 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?

YesNo

Please list the medication, dosage and what it was prescribed for

0 /

If this problem continues, I will:

Home Diagram

Please provide a diagram of your house. A basic floor plan using simple boxes is sufficient. Please be sure to include the following: location of litter boxes, food, water, cat trees, access to windows, doorway thresholds between rooms, rooms that cat is not allowed access to and be sure to notate any soiled areas if you are filling this out for elimination issues.

Upload your diagram

Legal Stuff

By 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.

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