Behavior Questionnaire Behavior Questionnaire For pricing and consult details, visit the Behavior Consulting page. This form is long but necessary to provide the best consultative experience possible, so please set aside the appropriate time to complete this form in one sitting. ***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 * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Cell Phone * Alternate Phone Email * Pet Information If completing this form for multiple cats, please choose cat of greatest concern for the section below. You will have the opportunity to provide details about additional cats as you proceed through the form. Pet Name * Breed * Date of Birth * Age * Sex * Female Male Neutered/Spayed * Yes No Please explain why your cat is not Neutered/Spayed * Is your cat declawed? * Yes No Which paws? * Front Only All Four Were there complications from the declaw surgery? * (i.e. infection) Does your cat go outdoors? * Yes No Please describe how often and how much access your cat has to the outdoors * (free to roam all day, leash, cat door, balcony/deck, only when I'm outside, etc.) Do any of your other cats have access to the outdoors? * Yes No How do you feed your cat? * (i.e. food out all the time, meals, timed feeder, via food puzzles, etc.) What brand(s) of food does your cat currently eat? * What type of food do you feed? * Canned Dry If you do not feed canned food, does your cat like it? * If you do not feed dry food, does your cat like it? * Does your cat like cat treats or any human foods? If yes, please list ALL of them! * General Information Who referred you to us? * Who is your regular veterinarian? * Clinic Name * Clinic or doctor's direct email * Clinic Address Clinic Address Clinic Address Clinic Address City City State/Province State/Province Zip/Postal Zip/Postal Clinic Phone Number * Have you visited your vet for this problem? * May we contact them for your records?* * Yes No *Granting permission to acquire records is helpful but it would be best if you simply contacted your vet and asked them to email specifically doctor's notes and lab results to [email protected]. This will expedite the process as most vets will reach out to the pet parent for permission to release the records if I call to request them. Cat's Background Why did you decide to get a cat? * Why this particular breed, sex, color? * 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 * Has your cat had other owners? * Yes No Don't know How long have you had this cat? * Behavior Problem What is your main behavior problem or complaint? * When did this problem start? * Do you recall anything specific at the onset of the behavior problem? * (i.e. moving, birth of a child, houseguests, construction, parties, etc.) How frequently does the problem (or problems) occur? * Has the problem changed in frequency or intensity? * What have you done so far to correct the problem? * How do you discipline your cat for this problem? * Rate this problem on a scale of 1-10, with 10 being the worst * 1 2 3 4 5 6 7 8 9 10 Are there any secondary problems or concerns? * Elimination Behavior How often does your cat use the litter box? * Occasionally Never Only urinates Only defecates Always If your cat does not consistently use the litter box, where in the house are they eliminating? * (dirty laundry, bed, sofa, hardwood floor, etc.) How many times a day does your cat urinate? Describe the size of the urine clumps. * How many times a day does your cat defecate? Describe the consistency of the stools. * (size of fecal balls, amount, firm, soft, formed, runny, etc.) How many litter boxes do you have? How many different litter box locations do you have? * Do you have traditional litter pans? * Yes No How many, and what are the dimensions? * Do you have commercial litter boxes with removable “lip”? * Yes No How many commercial litter boxes with removable “lip”? * Do you have covered boxes, “cave”-type front door? * Yes No How many covered boxes, “cave”-type front door? * Do you have covered boxes, “Booda” type (cat crawls into hole)? * Yes No How many covered boxes, “Booda” type (cat crawls into hole)? * Do you have automatic litter boxes (i.e. Littermaid, Litter-Robot)? * Yes No How many automatic litter boxes (i.e. Littermaid, Litter-Robot)? * Do you use the Tidy Cats Breeze System? * Yes No How many Tidy Cats Breeze System(s)? * Do you have any top entry litter boxes such as the "Clever Cat" box? * Yes No How many top entry litter boxes? * Do you have any other types of litter boxes? * Yes No Can you describe the other litter boxes you have and how many of each? * How old is each litter box? * Where are the litter boxes located? * Do you have a pet door leading to the litter box area? * What type of liners do you use? * How often do you scoop the litter box? * How often do you completely empty and scrub the box clean? * What type of cleaning products do you use? * (If they have a scent, please describe the scent (i.e. lemon, citrus, vanilla, etc.) Do you refill it with clean litter? * What brand(s) of litter do you use? * What other litter brands have you tried? * Do you change litter brands often? * Yes No What type of litter? Please check all that apply. * Scoopable/Clumping (clay) Non-scoopable (clay) Scented Unscented Crystal Pine Pelleted Grass Based Other If Other, please describe * You said you use a non-scoopable litter, do you scoop out urine or mix it in with the remaining litter? * Scoop out urine Mix it in with remaining litter How do you clean/scoop/maintain the box with the non-scoopable litter? * 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 Home Environment Please list all people, including you, living in the household include ages and their relationship/role in caring for the cat * Please list all animals in the household, include ages, breeds and any information you feel may be relevant * Please describe your cat’s relationship to the other animals * (i.e. friendly, hostile or fearful) Have you moved since acquiring your cat? * Yes No How many times? * Where does your cat sleep at night? * Do you have any areas if your home that are off limits to the cat(s)? * Yes No Where? Why? Have they always been off limits? * Are they allowed in these areas some of the time and not others? * Social Behavior Where is your cat when alone in the house? * How does your cat behave when you return home? * Where is your cat when you have guests? * How does your cat behave with adult visitors? * How does your cat react to visiting children? * How does your cat respond to other cats seen out of the window or in the yard? * How does your cat behave at the veterinarian? * How would you describe your cat’s overall personality? * When does your cat hiss or growl? * Does your cat bite you? * Yes No What are you doing when this happens? * Does your cat scratch you? * Yes No What are you doing when this happens? * Does your cat vocalize? * Yes No Does it happen excessively? At what time of the day? * Play Behavior What is your cats overall activity level? * What toys does your cat prefer? * Does your cat carry toys/objects around the house or “mother” other animals or objects? * Does your cat chew/suckle/lick strange objects or clothing? * How do you play with your cat? * Does your cat have a favorite scratching post or scratching area? * Yes No Please describe the post or area. * Include height, substrate and location Do you have cat trees? * Yes No Please describe the type of condos, where they are located and if your cats use them * Do you trim you cat’s nails? * What does your cat scratch on you wish he/she would not? * Sexual Behavior At what age was your cat spayed or neutered? * Were there any complications with the surgery? * Were there any behavior changes after the surgery? * Does your cat mount other cats, objects or people? * Does your cat vocalize, flag her tail (whipping from side to side) or tread (make biscuits) with her back feet? * Has he/she ever been bred? * Are you planning to breed your cat in the future? * Grooming Behavior Does your cat groom, lick or bite himself excessively? * Does your cat have bald patches? * Yes No Where are they located? * Does your cat’s skin ripple or twitch? * Yes No Does this happen after petting or without being touched at all? * Does your cat chew or suckle its tail? * Would you say your cat is a good groomer? * (i.e. coat is well maintained without you having to brush or bathe them) Daily Routine Have there been any changes in your routine lately? * Have any recent activities been stressful to your cat? * (i.e. parties or construction) Who feeds your cat? Where are the food bowls located in the home? * Where does your cat drink? * Do you find he/she drinks excessively? * 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.) Is your cat currently on any medication? * Has your cat been on medications in the past? * Yes No Please list the medication, dosage and what it was prescribed for? * If this problem continues, I will: If this problem continues, I will * Ignore It Continue to seek help and work on the problem Give my cat away Put my cat outside Euthanize my cat Home Video Please submit a brief video of your home utilizing the upload feature below or you may email it directly to [email protected]. You may also use Google Drive, Dropbox or similar, whatever format is easiest for you. 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. Upload videos or photos of your house Drop a file here or click to upload (multiple photos and videos allowed) Choose File Maximum file size: 516MB 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. If you are human, leave this field blank. Submit
