CAT BEHAVIOR QUESTIONNAIRE

 

email the completed questionnaire to dustycatwriter@pobox.com

Name:

Address:

City:

State:

Zip:

Phone (day):

Phone (evening):

Best time of day to be reached:

E-mail:

ABOUT YOUR CAT

Cat’s name:

Breed:

Age:

Longhair ___ Medium hair ___ Shorthair ___

Male ___ Female ____ Is your cat altered? ___  When? ___  Declawed? ___  When? ___

Age ___

How long you have owned your cat?

How old was your cat when you got him/her?

Where did you get your kitty? Rescue___  Municipal Shelter ___  Humane Shelter  ___ Adopt-a-

Pet ___ Friend ___   Pet store ___   Other__________________

Where does your kitty live? Indoor only ___  Outdoor only ___   Indoor/Outdoor

Past injuries or physical problems_______________________________________________________

Weight_________________

When did the cat last see the vet?______________________________

VETERINARIAN CONTACT INFO:

Vet’s name:\nPhone number:\nE-

mail:\nPast Medical Problems:\nHas your cat ever had a bladder infection or

blockage?\nWhen?\nCurrent Medical Problems:\nWhat medications is your cat

taking?\nHow are medications given?\n\nFAMILY INFORMATION\n\nList all

people living in home:\nName                  Â

Gender                             Â

  Adult/Child (Age)           Â

Relationship                           Â

           Occupation\n

\n1)\n2)\n3)\n4)\n5)\n6)\n7)\n8)\n9)\n10)\n\nDo you receive visits from people or

children outside the family?\n\nOther animals living with the family:

\nSpecies/Breed  Gender                Age

acquired     Current age        Interaction with subject Cat

\n1)\n2)\n3)\n4)\n5)\n6)\n\nAre there more pets?\nHave you gotten new pets after

you acquired the cat?\nChanges in household since pet acquired (including

moves)\nHave you moved since your acquired the cat?\nWhen?\n\nCAT\’S

ENVIRONMENT & ROUTINE\n\nArea:     Â

£Urban              £Suburban        £Rural

\nHome:  £ Apartment   £Attached House  £Single Family

House   £Other:\nWhere is the cat kept? Â

£Inside              £Outside          Â

£Inside/outside\nAre Rooms off Limits?  £ No   £Yes\nWhich rooms?

\nWhere does He/she sleep?\nWhere is he/she fed?\nWho feeds him/her?\nHow

many litter boxes are there in the house?\nWhere are they located?\nWhat kind of

flooring is the litter box on?\nWhat kind of cat litter do you use?\nDo you use litter

mats? £Yes    £No     What kind?\nFavorite spots to rest?\nWhat

tends to go on where and when it spends it\’s time?\nWho spends the most time

with the cat?\nWhat is available for the cat to play with?\nDescribe typical day:\n

\nHOUSE RULES\n\nCan\’t do…..\nAllowed to do when \”asks\”…..\nAllowed

complete freedom to…\n\nCAT\’S DIET\n\nWhat does your cat eat?\nCanned

food:\nWhen is cat fed?\nHow much?\nHow much is usually eaten?\n\nDry food:

\nWhen is cat fed?\nWhen is hard food available?\nHow much is usually eaten?

\nOther parts of regular diet:\n\nTreats: hand-fed items or items not regular part of

diet\nFavorite Treat (gets excited over and/or quickly takes):\nHow cat gets

treats?       £ in dish   £Placed somewhere else   £Hand-

fed\n\nAny further details:\nWhere and when are the other pets fed?\n\nCAT\’S

BEHAVIORS\n\nThe Problem(s): Mark all behaviors that apply with: Most

Serious     Somewhat Serious     Less serious Problem\n\nBiting or

other aggression towards:\n__________________People

\n__________________Other cats\n__________________Other pets

\n__________________ Elimination outside the litter box

\n__________________Excessive fear, including fear of separation

\n__________________Destructive behavior (tearing /scratching / chewing

without ingesting)\n__________________Non-food eating problems (including

plants)\n__________________Food eating problems/begging

\n__________________Sucking / non-aggressive mouthing / play attacks

\n__________________ Overgrooming\n__________________ Going into or

onto off-limit area (such as jumping on counter or bolting out the

door)\n_________________Other:\n_________________Other:\nOther

Behaviors\nHow does your cat react to:\nStrangers?\nFamily friends?\nVet visits?

\nThe person who grooms him/her?\nEntering the cat carrier?\nChanges in

household since pet acquired (including moves)\n\nCAT\’S MOST SERIOUS

PROBLEM\nDescribe problem in detail, include chronological list of recent events

and changes in behavior:\nProblem:\nHistory:\nDid the cat have the problem when

acquired?    £Yes   £ No\nDid the cat develop the problem

afterwards?      £Yes    £No\nWhen was the problem

apparent?\nHow old was the cat?\nHow often does it occur?

             £daily     £weekly    £ monthly

\nUsual circumstances when the problem occurs:\nOther times when happens:

\nWhat we have tried so far to correct it and what results that has had:\n

\nADDITIONAL INFORMATION:\nSection 8.2: Pet\’s Next Most Serious

Problem\n\nDescribe problem in detail, include chronological list of recent events

and changes in behavior:\nProblem:\nHistory:\nDid the cat have the problem when

acquired?    Yes    No\nDid the cat develop the problem afterwards?

      Yes    No\nWhen was the problem apparent?\nHow old was

the cat?\nHow often does it occur?             daily   Â

weekly     monthly\nUsual circumstances when the problem occurs:\nBut

the problem sometimes happens when…\nWhat we have tried so far to correct it

and what results that has had:

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