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Cat Behavior Questionnaire
Please enable JavaScript in your browser to complete this form.
Owner's Name
*
First
Last
Email
*
Appointment Date and Time (if already scheduled)
Date
Time
Pet's Age
Pet's Breed
Pet's Sex
How long have you had your cat?
How old was your cat when you first acquired him/her?
Where did you get your cat?
Has this dog cat other owners?
Yes
No
If yes, how many?
How much time does your cat spend indoors? (%)
How much time does your cat spend outdoors? (%)
Is your cat left alone during the day?
Yes
No
If yes, for how long?
If kept indoors, is your cat restricted to a specific area or room in the house?
Yes
No
How many times daily do you play with toys or play games with the cat (on average)?
Does your cat get along well with other animals?
Yes
No
If no, please explain:
How does your cat behave in veterinary offices and while being examined?
How does this cat react to unfamiliar people?
How does this cat react to children?
Are there stray or neighbor cats around your home?
Yes
No
If yes, how does your cat react if he/she sees them?
Please list all people, including yourself, living in your household:
Name
Hours away from home
Age
Name
Hours away from home
Age
Name
Hours away from home
Age
Name
Hours away from home
Age
Name
Hours away from home
Age
Please list all animals, including the one you are bringing in to see us, in your household:
Name
Species/Breed
Sex/Neutered?
Age
Name
Species/Breed
Sex/Neutered?
Age
Name
Species/Breed
Sex/Neutered?
Age
Name
Species/Breed
Sex/Neutered?
Age
Name
Species/Breed
Sex/Neutered?
Age
Elimination Behavior:
How many litter boxes do you have?
Where is each litter box located in your house?
What type of litter boxes do you have? (ie: covered, open, small, large, liners used)
What kind of litter material is used in the boxes?
How frequently is the urine or feces scooped?
How frequently is the litter entirely changed?
How frequently is the litter box washed and the contents replaced?
Are deodorants such as bleach or Lysol used in the cleaning process?
Yes
No
Does the cat ever vocalize while he/she eliminates?
Yes
No
Does the cat ever run out of the box after eliminating?
Yes
No
Does your cat ever eliminate outside of the box, in the house?
Yes
No
If yes, does he/she urinate or defecate or both out of the box?
Where, exactly does your cat eliminate outside of the box, in your home?
How long has your cat been eliminating outside of the box?
Behavior Problem Information:
Please describe your cat’s behavior problem:
How often does this problem occur?
What has been done so far to correct this problem? (discipline, confinement, etc)
What was your cat’s response to the correction?
Please describe all situations which are likely to elicit aggressive behavior such as growling, nipping, biting, attacking, etc. (ie: petting, approached by adults, approached by children, punishing, etc)
Please indicate any other behavior problems: (Select all that apply)
House soils
Shy
Bites during play
Aggressive if verbally scolded
Attacks people
Runs away
Destructive scratching
Bites during petting
Excessive grooming
Fighting
Digging
Please discuss any other information you feel is relevant to your cat's problem:
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