Home » Feline Behavior Questionnaire

Feline Behavior Questionnaire

General Information

Today's Date(Required)

Date and time of consultation (if scheduled)

First Name(Required)

Last Name(Required)

Address(Required)

Street Address

City/Town

ZIP / Postal Code

Phone Number(Required)

Email(Required)

Alternate Phone Number

Preferred method of contact(Required)

Veterinary Clinic(Required)

Veterinarian's Name(Required)

Clinic Phone(Required)

Who referred you to our service?(Required)

Pet Information

Pet's Name(Required)

Date of birth or estimated age(Required)

Weight in lbs(Required)

Sex(Required)

Male

Female

Neutered(Required)

Yes

Any changes after neutering?(Required)

Yes

Describe the changes you noticed after neutering(Required)

Breed(Required)

Color(Required)

Declawed(Required)

Yes

At what age was the cat declawed?(Required)

Describe any changes noted after declaw?(Required)

Your Pet's Early History

Age obtained?(Required)

From where did you obtain this pet?(Required)

Name of Breeder / Shelter(Required)

Describe previous home (if known) including litter size, how raised, age weaned, other pets, family

Describe (if known) how much interaction your cat has had with people or other pets before it was obtained

Behavior of parents or littermates (if known)

For what reason did you obtain this cat? (check all that apply)(Required)

Companion for family

Companion for cat

Rodent control

Breeding/show

Other

Describe your cat’s personality (check all that apply)(Required)

Describe "Other" reason why you purchased the cat.(Required)

Describe the "Other" part of your cat's personality(Required)

The Home Environment

List each family member living in the home (include age of children)(Required)

* Maximum entries of 10 people

Name

Age

Occupation

Describe how your pet gets along with each family member including any problems:(Required)

List all other pets in the home(Required)

* Maximum entries of 4 pets

Name

Species

Breed

Sex

Age

Relationship

Describe if any of the pets do not get along with each other(Required)

Your Cats Activities

Diet and Nutrition

Type of food: when do you feed / feeding routine(Required)

What food does your cat prefer?(Required)

Describe your pet’s appetite(Required)

Do you give treats?(Required)

Yes

Type of treats?(Required)

What treats does your cat prefer?(Required)

Describe your pet’s interest / appetite for treats(Required)

When and how often do you give treats?(Required)

Does your cat hunt?(Required)

Yes

When and how often does your cat hunt?(Required)

List any food supplements or additives(Required)

What is your cat’s favored prey?(Required)

Does your cat eat the prey?(Required)

The Home Environment

Describe you and your cat’s daily schedule(Required)

Does your cat spend time outdoors?(Required)

Yes

If yes to cat spending time outside, select an option(Required)

Confined to the yard

On harness

Free to roam

Cat door

If outdoors, describe when, where and how often?(Required)

Does your cat see, hear or come in contact with outdoor cats?(Required)

Yes

If yes, please describe the contact with other outdoor cats(Required)

Have you used a crate for housing or travel?(Required)

Yes

If yes, describe cat’s reaction to the crate(Required)

Where is your cat’s favorite sleeping spot / resting area / bed during the night?(Required)

Where is your cat’s favorite sleeping / resting / bed / perching area during the day?(Required)

Does your cat have a favored climbing / perching area / play centre?(Required)

Yes

If yes, please describe(Required)

Does your cat climb / perch / play in areas that are undesirable to you?(Required)

Yes

If yes, please describe(Required)

Does your cat have a scratching area / preferred scratching location?(Required)

Yes

If yes, please describe(Required)

Does your cat scratch in areas that are undesirable?(Required)

Yes

List undesirable locations?(Required)

When and how often does your cat scratch these locations?(Required)

Are there specific events that precede scratching?(Required)

Yes

If yes, what specific events preceed scratching? (When they wakup from a nap, etc)(Required)

Do see your cat scratching?(Required)

Yes

If yes, what do you do about the cat scratching?(Required)

Cat’s reaction: What do you do when you find an area that your cat has scratched?(Required)

Cat’s reaction: What have tried so far to treat the scratching and what, if anything has been effective?(Required)

Cat’s Environment – Please email pictures or video of your home including where problems occur

Describe home(Required)

Detached family home

Town (row) house/ semi-detached

Apartment / high rise rental

Condo / high rise owned

Rented room / basement

Trailer home

Other

Please describe home(Required)

How many stories?(Required)

How many rooms?(Required)

Please draw a diagram of each floor of your home or upload photos as necessary. (Use additional pages for other floors) Label each room. Identify windows and doors. Identify any large furniture. Also indicate type of floor for any areas soiled.(Required)

Use the codes below to label litter box locations, feeding areas, play stations, resting areas, and problems. L: Litter – please number each location e.g. L1, L2, L3 etc. – F: feeding location: – P – play area / play center: SP: for Scratching post – SD: Sleep / resting locations (day) – SN: Sleeping locations (night) W: Window
Problems: U: site of urine soling – M: site of urine marking (upright surfaces) – BM: site of stool soiling – S: site of destructive scratching.

Upload any necessary photos or diagrams of your floor plan

Max. file size: 50 MB.

Principle Complaint

The following questions are required to assess your pet’s problem. It is not necessary to duplicate answers from previous sections or in future sections. Please consider emailing movie clips or pictures of the problem behaviors and the cat’s environment.(Required)

List all Problems that need to be addressed. Begin with your primary complaint

Age problem began

Very Serious

Fairly Serious

Not Serious

Have you considered removing your cat from the home if the problem cannot be improved?(Required)

Yes

Comment about removing your cat from the home.(Required)

What are your goals for this consultation?(Required)

For the primary problem(s) what age was your cat when the problem started?(Required)

Describe any changes in the home or the pet’s health when the problem first started:(Required)

What do you think caused the problem?(Required)

Describe the problem, beginning with the most recent incident?(Required)

Describe the first incident and any other pertinent incidents:(Required)

How often does the problem occur?(Required)

Has there been a recent change in frequency or severity?(Required)

Yes

Please describe the recent changes in frequency and severity.(Required)

List each behavioral treatment you have tried (other than drugs), and the cat’s response(Required)

Date / When

Treatment

Cat's Response / Outcome

Which approach has been most successful (if any)?(Required)

List any techniques that have made the problem worse(Required)

List any medications, supplements or remedies tried so far, and the cat’s response (effects, side effects)(Required)

Date

Medication (when started, dose, frequency, duration)

Outcome (effects, side effects, is pet still receiving)

Training

Have you or your cat had any formal training?(Required)

Yes

If yes, select the type of formal training(Required)

Attend kitten classes

In-house instructions

Other

Describe other type of formal training(Required)

Have you done any of your own training with your cat?(Required)

Yes

Describe the type of training you did with your cat.(Required)

What sources (books, DVD, websites) have you used for advice on cat behavior and training if any?

Does your cat respond to any commands / cues?(Required)

Yes

If yes, select all that apply(Required)

Sit

Down

Come

Go to e.g. bed / room

Other trained commands

Please list other training commands that your cat responds to(Required)

Who does your cat respond to the best?(Required)

List any tricks your cat can perform(Required)

Describe your cat’s learning ability:

If you wanted to get your cats attention or get your cat to come what would work best (e.g. shaking a box of treats, command)?(Required)

How successful would this be?(Required)

Very

Most times

Occasionally

Unsuccessful

Describe level of success(Required)

List your cat’s top 3 food or treat rewards(Required)

List your cat’s top 3 non-food rewards (e.g. toy, affection)(Required)

Have you used any of the following for training?

Positive reinforcement(Required)

Yes

Effect of positive reinforcement(Required)

No effect

Worsens

Effective

Positive reinforcement comments

Lure / reward training(Required)

Yes

Effect of lure / reward training(Required)

No effect

Worsens

Effective

Lure / reward training comments

Food / treat rewards(Required)

Yes

Effect of food / treat rewards(Required)

No effect

Worsens

Effective

Food / treat rewards comments

Toy / play reward(Required)

Yes

Effect of toy / play reward(Required)

No effect

Worsens

Effective

Toy / play reward comments

Affection / reward(Required)

Yes

Effect of affection / reward(Required)

No effect

Worsens

Effective

Affection / reward comments

Clicker training(Required)

Yes

Effect of clicker training(Required)

No effect

Worsens

Effective

Clicker training comments

Assertive / confront(Required)

Yes

Effect of assertive / confront(Required)

No effect

Worsens

Effective

Assertive / confront comments

Body harness(Required)

Yes

Effect of body harness(Required)

No effect

Worsens

Effective

Body harness comments

Collar(Required)

Yes

Effect of collar(Required)

No effect

Worsens

Effective

Collar comments

Punishment / Discipline / Corrections used

Verbal reprimand (no)(Required)

Yes

Effect of verbal reprimand(Required)

No effect

Worsens

Effective

Verbal reprimand comments

Physical punish – hit(Required)

Yes

Effect of physical punish(Required)

No effect

Worsens

Effective

Physical punish comments

Scruff / neck grasp(Required)

Yes

Effect of scruff / neck grasp(Required)

No effect

Worsens

Effective

Scruff / neck grasp comments

Physical lift / pin(Required)

Yes

Effect of physical lift / pin(Required)

No effect

Worsens

Effective

Physical lift / pin comments

Shake can / noise(Required)

Yes

Effect of shake can / noise(Required)

No effect

Worsens

Effective

Shake can / noise comments

Ultrasonic(Required)

Yes

Effect of ultrasonic(Required)

No effect

Worsens

Effective

Ultrasonic comments

Water spray(Required)

Yes

Effect of water spray(Required)

No effect

Worsens

Effective

Water spray comments

Air or citronella spray(Required)

Yes

Effect of air or citronella spray(Required)

No effect

Worsens

Effective

Air or citronella spray comments

Booby trap / repellent(Required)

Yes

Effect of booby trap / repellent(Required)

No effect

Worsens

Effective

Booby trap / repellent comments

Time-out / confinement(Required)

Yes

Effect of time-out / confinement(Required)

No effect

Worsens

Effective

Time-out / confinement comments

Have you used any other punishment not listed above?(Required)

Yes

If yes, please describe(Required)

What punishment is most effective?(Required)

Has punishment made the problem worse or resulted in aggression?(Required)

Yes

Describe “which” method of punishment made the problem worse or resulted in aggression(Required)

If yes, please describe how the problem worsened or resulted in aggression.(Required)

Does your cat respond differently to punishment from different family members?(Required)

Yes

If yes, pleasee describe how they act differently to punishment from a different family member.(Required)

Play and Activities

Interactive / Social Play

Do you play with your cat?(Required)

Yes

If yes, what is favored game(Required)

Describe when, how often, with whom(Required)

Object / Exploratory Play

Does your cat engage in play on its own?(Required)

Yes

Level of interest(Required)

High

Low

None

How often(Required)

Describe / Favorite

Does your cat engage in over-exuberant or unacceptable play?(Required)

Yes

Please describe bahavior during play(Required)

Does your cat chew on or swallow objects that are inappropriate / undesirable?(Required)

Yes

Please describe the objects(Required)

Handling

Petting / stroking head / neck(Required)

Unknown

Enjoys

Resists

Accepts willingly

Accepts reluctantly

Threatens / aggressive

Cannot attempt

Petting / stroking back / tail(Required)

Unknown

Enjoys

Resists

Accepts willingly

Accepts reluctantly

Threatens / aggressive

Cannot attempt

Rubbing belly(Required)

Unknown

Enjoys

Resists

Accepts willingly

Accepts reluctantly

Threatens / aggressive

Cannot attempt

Brushing(Required)

Unknown

Enjoys

Resists

Accepts willingly

Accepts reluctantly

Threatens / aggressive

Cannot attempt

Hugging / kissing(Required)

Unknown

Enjoys

Resists

Accepts willingly

Accepts reluctantly

Threatens / aggressive

Cannot attempt

Restrained on your lap(Required)

Unknown

Enjoys

Resists

Accepts willingly

Accepts reluctantly

Threatens / aggressive

Cannot attempt

Nail trimming(Required)

Unknown

Enjoys

Resists

Accepts willingly

Accepts reluctantly

Threatens / aggressive

Cannot attempt

Ear handling / cleaning(Required)

Unknown

Enjoys

Resists

Accepts willingly

Accepts reluctantly

Threatens / aggressive

Cannot attempt

Eye cleaning / medicating(Required)

Unknown

Enjoys

Resists

Accepts willingly

Accepts reluctantly

Threatens / aggressive

Cannot attempt

Bathing(Required)

Unknown

Enjoys

Resists

Accepts willingly

Accepts reluctantly

Threatens / aggressive

Cannot attempt

Teeth brushing(Required)

Unknown

Enjoys

Resists

Accepts willingly

Accepts reluctantly

Threatens / aggressive

Cannot attempt

Lifted / carried(Required)

Unknown

Enjoys

Resists

Accepts willingly

Accepts reluctantly

Threatens / aggressive

Cannot attempt

Giving medication(Required)

Unknown

Enjoys

Resists

Accepts willingly

Accepts reluctantly

Threatens / aggressive

Cannot attempt

Describe any problems in more detail

Are there differences in the way the cat responds to different family members?(Required)

Fear and Reactivity – Indicate how your cat reacts to each of the following

Familiar cats in home(Required)

Describe your cat's reaction

Unfamiliar cats in home(Required)

Describe your cat's reaction

Cats outside home(Required)

Describe your cat's reaction

Unfamiliar visitors to home(Required)

Describe your cat's reaction

Familiar visitors to home(Required)

Describe your cat's reaction

Veterinary visits(Required)

Describe your cat's reaction

Thunderstorms / fireworks(Required)

Describe your cat's reaction

Other noises

Please describe other noises and your cat's reaction to that noise(Required)

Describe any of these problems in greater detail

Is there anything not listed previously that might cause your cat to become fearful, anxious or aroused(Required)

Yes

If yes, describe what makes your cat fearful, anxious, or aroused(Required)

Describe your cat’s level of arousal in these situations:(Required)

Mild

Moderate

High / Excessive

How long after exposure to these events has passed, does it take for your cat to settle down (i.e. back to normal)(Required)

Are there any problems when travelling?(Required)

Yes

If yes, describe problems when traveling(Required)

What do you do to try and correct the problem?(Required)

What is the cat's reaction?(Required)

Describe how you transport your cat? (e.g. Carried by family member, on seat, carrier)

Aggression

Does your cat ever display aggression to people or other animals?(Required)

Yes

Is aggression the primary reason for today’s visit?(Required)

Yes

Describe severity?(Required)

Mild

Moderate

Severe

Please indicate to which of the following your cat has shown aggression(Required)

Does the aggression occur when owners are:(Required)

Present

Absent

Both

Please list the the situation and aggressive behavior(Required)

Have you considered removing your pet from the home if the problem cannot be improved?(Required)

Yes

If yes, comment about your consideration of removing the pet from the home.(Required)

In what situations does your cat display aggression?(Required)

How often has the problem occured?(Required)

Is the problem:(Required)

Getting better

Staying the same

Getting worse

Describe the aggression:(Required)

Threats but no bite

Bites but does not break skin

Bite with minor injury

Serious injury

Other

Please describe the "Other" aggression.(Required)

Describe your cats demeanor at the time of aggression:(Required)

Playful

Fearful

Bold / Assertive

Other

List "Other" cats demeanor at the time of aggression.(Required)

Describe the most recent event: What happened immediately prior to the event?(Required)

Describe the event(Required)

Describe your cat’s appearance (body posture, face, ears, tail, hair on back)(Required)

What did you do at the time?(Required)

What was your cat’s reaction?(Required)

Has any treatment used to date been effective?(Required)

Yes

If yes, describe what treatment has been effective.(Required)

Has any treatment made the problem worse?(Required)

Yes

If yes, describe what treatment made the problem worse.(Required)

Elimination & Litter Information

How Often do the Following Events Occur?

Cat urinates in litter box(Required)

Cat urinates in litter box comments / describe

Cat urinates outside box(Required)

Cat urinates outside box comments / describe

Cat sprays urine / marks(Required)

Cat sprays urine / marks comments / describe

Cat defecates in litter box(Required)

Cat defecates in litter box comments / describe

Cat defecates outside box(Required)

Cat defecates outside box comments / describe

Cat eliminates outdoors(Required)

Cat eliminates outdoors comments / describe

Litter box is scooped out(Required)

Litter box is scooped out comments / describe

Litter replaced with new litter(Required)

Litter replaced with new litter comments / describe

Litter box cleaned and washed(Required)

Litter box cleaned and washed comments / describe

Litterbox Information(Required)

Litter location – indicate what preferred by each cat

Type of litter

Type of box

List up to 10 litterboxes

Does your cat ever use its litter box while you are watching?(Required)

Yes

Indicate which box(es) your cat prefers:(Required)

Indicate which box(es) your cat seldom or never uses:(Required)

Indicate which litter your cat prefers:(Required)

Indicate which litter your cat seldom uses or avoids:(Required)

Does your cat dig / bury before or after eliminating?(Required)

Yes

If yes, describe how your cat dig / bury before or after eliminating.(Required)

Indicate any differences between your cats as to their preferred litter or box:(Required)

Elimination Problems

Does your cat have a problem with housesoiling or marking(Required)

Yes

Is elimination the primary reason for today’s visit?(Required)

Yes

Is the problem(Required)

Getting worse

Staying same

Improving

Is the soiling(Required)

Stools

Urine

Both

Is the soiling(Required)

Only on horizontal surfaces (floors)

Only on vertical (upright)

Mostly upright and some horizontal

Mostly horizontal and some upright

Both upright and horizontal

Stool: At the time the problem began describe your pet’s stool(Required)

Normal

Constipation

Less frequent

More frequent

Soft/diarrhea

Straining/discomfort

Vocalization

Any changes from normal stool? If so, describe.

Are there any ongoing abnormalities in stool?(Required)

Yes

If yes, describe ongoing abnormalities in stool.(Required)

Urine: At the time the problem began describe your pet’s urine(Required)

Normal

Constipation

Less frequent

More frequent

Soft/diarrhea

Straining/discomfort

Vocalization

Blood

If any changes from normal urination, please describe

Are there any ongoing abnormalities in urine?(Required)

Yes

If yes, describe abnormalities in urine.(Required)

Has there been any change in appetite?(Required)

Yes

If yes, describe changes in appetite.(Required)

Has there been any change in drinking?(Required)

Yes

If yes, describe changes in drinking.(Required)

Was your pet ever completely “litter trained”?(Required)

Yes

If yes, describe litter training.(Required)

Locations soiled(Required)

Inappropriate Locations Soiled

Surface

Urine, Stool, or Both

When / How Often

* You can include up to 5 locations soiled

When your cat is indoors, what percentage of urine is outside of the box?(Required)

When your cat is indoors, what percent of stool is outside box(Required)

Is there a particular surface / texture on which your cat prefers to soil?(Required)

Yes

If yes, describe particular surface / texture(Required)

Are there any surface types where your cat never soils?(Required)

Yes

If yes, describe particular surface / texture(Required)

Is there a room or location where your cat prefers to soil?(Required)

Yes

If yes, describe the location(Required)

Is there a room or location where your cat never soils?(Required)

Yes

If yes, describe the location(Required)

Is there a time of day when the problem is most likely to arise?(Required)

Can you think of any pattern when the problem is most likely to arise?(Required)

Have seen your cat when it is soiling?(Required)

Yes

If yes, describe what you do and the cat's reaction.(Required)

Types of Litters(Required)

List types of litter that you have tried?

Indicate cat’s response (e.g. Uses readily, Uses but not a favorite, Avoids)

* Max entries of 4

What is your cat’s favorite litter?(Required)

List favorite cat litter

Indicate cat’s response (e.g. Uses readily, Uses but not a favorite, Avoids)

* Max entries of 4

Types of boxes?(Required)

List types of boxes that you have tried?

Indicate cat’s response (e.g. Uses readily, Uses but not a favorite, Avoids)

* Max entries of 4

What is your cat’s favorite box?(Required)

Have you tried litter with deodorizer?(Required)

Yes

If yes, describe the litter with deodorizer and how the cat liked/disliked it.(Required)

Have you tried different depths of litter?(Required)

Yes

If yes, describe how the depths of litters affected the cat.(Required)

What age was your pet when this problem started?(Required)

Describe the first incident:(Required)

Were there any changes in the household or litter when the problem began?(Required)

Yes

What do you think caused the problem?(Required)

What has been done so far (other than drugs) to try and correct the problem and how did the cat respond?(Required)

List any techniques that have been successful(Required)

List any techniques that have made the problem worse(Required)

List any drugs or pheromones tried so far and the cat’s response to the medication (efficacy, side effects):(Required)

Grooming

Does your cat’s self grooming appear to be:(Required)

Normal

Excessive

Decreased

When is your cat most likely to groom?(Required)

Describe situations or events that lead to increased grooming(Required)

Describe situations or events that lead to decreased grooming(Required)

Does your cat lick or groom:(Required)

Self

Other cats in house

People in home

Household objects

Other

Please describe the licking/ grooming behavior(Required)

Are any of these behaviors excessive or problematic?(Required)

Yes

If yes, please describe the behaviors(Required)

Does your cat knead?(Required)

Yes

If yes, please describe when and with whom(Required)

Do you feel your cat’s kneading is unusual or excessive?(Required)

Yes

If yes, please describe(Required)

If this is the primary reason for today’s visit, please provide more details in the Primary Complaint Section:

Feline Skin Disorders

Does your cat have problems with overgrooming, rippling skin, excessive scratching or hair loss?(Required)

Yes

Is a skin disorder the reason for today’s visit?(Required)

Yes

If yes, is the problem:(Required)

Getting better

Staying the same

Improving

Describe the skin problem(Required)

When did the problem first begin? (cat’s age, time of year, etc.)(Required)

Do any pets in your home go outdoors?(Required)

Yes

If yes, which pets go outdoors(Required)

Were there changes in the household, which may have occurred just before the problem began?(Required)

Yes

If yes, please describe

Were there changes in the cat’s health or behavior when the problem began?(Required)

Yes

If yes, please describe

Has the severity, frequency, pattern or type of hair loss changed since the problem first arose?(Required)

Yes

If yes, please describe the hair loss changes(Required)

Is there a particular event that is most likely to cause or aggravate the problem?(Required)

Is there a particular time of month or time of year that the problem gets worse or begins to improve?(Required)

Is the behavior more likely to occur when you are:(Required)

At home but out of the room

At home in the room

Away from home

Do any other pets in the household have any skin problems?(Required)

Yes

Do any other pets in the household have any skin problems?(Required)

Yes

If yes, please describe other household pets with skin problems.(Required)

Have any other family members or friends developed skin problems?(Required)

Yes

If yes, please describe other family members or friends skin problems.(Required)

What has been done so far to try and correct the skin problem?(Required)

What was the cat’s response?(Required)

List any techniques or medications that have been at all successful(Required)

List any techniques or medications that have made the problem worse(Required)

List any drugs tried so far, and the cat’s response to medication (improvement / side effects)(Required)

Miscellaneous

Please answer the questions below.

Jumps on counters(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

Jumps on counters: Comments / describe

On furniture where not allowed(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

On furniture where not allowed: Comments / describe

In rooms where not permitted(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

In rooms where not permitted: Comments / describe

Nips / grabs – play bite(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

Nips / grabs – play bite: Comments / describe

Altered Sleep – night waking(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

Altered Sleep – night waking: Comments / describe

Hyperactive / over-exuberant(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

Hyperactive / over-exuberant: Comments / describe

Hiding / avoidance(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

Hiding / avoidance: Comments / describe

Not social – avoids affection(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

Not social – avoids affection: Comments / describe

Climbing(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

Climbing: Comments / describe

Vocalization(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

Vocalization: Comments / describe

Licking(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

Licking: Comments / describe

Tail chasing / attack(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

Tail chasing / attack: Comments / describe

Sucking(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

Sucking: Comments / describe

Snaps at air(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

Snaps at air: Comments / describe

Hyperesthesia (rippling skin)(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

Hyperesthesia (rippling skin): Comments / describe

Roaming / running away(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

Roaming / running away: Comments / describe

Mounting(Required)

Never

Occurs, but not a concern

Occurs, would like to improve

Mounting: Comments / describe

Other – Describe any problems not previously listed

Medical Screen

Please ensure we have complete medical records and the most recent diagnostic (lab) tests.

Attach medical records in most recent diagnostic tests here

Max. file size: 50 MB.

When was your cat’s last veterinary visit?(Required)

Reason for visit?(Required)

Are vaccines up to date?(Required)

Yes

If no, describe why vaccines are not up to date.(Required)

Does your pet have any ongoing medical problems?(Required)

Yes

If yes, describe ongoing medical problems.(Required)

Is your pet presently on any medication?(Required)

Yes

If yes, describe (include name, dosage, duration):(Required)

Has your pet had any laboratory tests?(Required)

Yes

If yes, describe when and what lab tests. Indicate any abnormal findings(Required)

Change in appetite?(Required)

Yes

If yes, describe change in appetite(Required)

Change in weight?(Required)

Yes

If yes, describe change in weight(Required)

Does your pet drink excessively?(Required)

Yes

If yes, describe (how often, how much)(Required)

Does your pet have arthritis or any other painful condition?(Required)

Yes

If yes, describe condition and treatment(Required)

Have you noticed any deficits in your pet’s senses?(Required)

Yes

If yes, describe deficits of pet's senses(Required)

Have you noticed any change in stool frequency (how often) or in the way it looks?(Required)

Yes

If yes, describe changes in stool(Required)

Have you noticed any change in the frequency of urination or any discomfort?(Required)

Yes

If yes, describe changes in urination(Required)

Have you notice any other health issues?(Required)

Yes

If yes, describe health issues(Required)

Comments

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