Cat Behavior Questionaire ABOUT YOU: Your name (required) Email (required) Address (required) Telephone (required) ABOUT YOUR CAT: Cat's name Breed or breed mix Weight Sex MaleFemale Spayed / Neutered? YesNo Is your cat declawed? YesNo Current age Age when you got him / her Where did you get your cat? BreederShelterRescue GroupFoundPrivate Adoption YOUR CAT'S BEHAVIOR: Briefly describe your cat’s behavior problems. List them in order of concern for you. When did you first notice these behaviors? Does your cat urinate or defecate outside of the litterbox? UrinationDefecationBothNo How often does this happen? When did this start? Where does this occur? What kind of litterbox(es) do you have? (Check all that apply.) CoveredOpenSelf-cleaning How big is the litterbox? How many litterboxes are in the home? How often do you scoop the litterbox? Describe any recent changes to related to the litterbox(es) in your home. Has your cat ever bitten a person? YesNo Describe the last three bite incidents as you remember them: BITE ONE Date and time of day Where was your cat when this happened?: Who did your cat bite:?: What part of the person’s body was bitten?: In your own words, briefly describe what was happening right before the bite occurred. What was the resulting injury from the bite (include injuries from scratches, too). How was the person bitten cared for? Click all that apply. No specific care givenWound was cleaned at homePerson was taken to an emergency medical facility for cleaning and bandagingPerson was taken to an emergency medical facility for stitchesPerson received prescription antibioticsSurgery was requiredPhysical therapy was required In your own words, describe how the cat behaved after the bite.: --- BITE TWO Date and time of day Where was your cat when this happened?: Who did your cat bite:?: What part of the person’s body was bitten?: In your own words, briefly describe what was happening right before the bite occurred. What was the resulting injury from the bite (include injuries from scratches, too). How was the person bitten cared for? Click all that apply. No specific care givenWound was cleaned at homePerson was taken to an emergency medical facility for cleaning and bandagingPerson was taken to an emergency medical facility for stitchesPerson received prescription antibioticsSurgery was requiredPhysical therapy was required In your own words, describe how the cat behaved after the bite.: --- BITE THREE Date and time of day Where was your cat when this happened?: Who did your cat bite:?: What part of the person’s body was bitten?: In your own words, briefly describe what was happening right before the bite occurred. What was the resulting injury from the bite (include injuries from scratches, too). How was the person bitten cared for? Click all that apply. No specific care givenWound was cleaned at homePerson was taken to an emergency medical facility for cleaning and bandagingPerson was taken to an emergency medical facility for stitchesPerson received prescription antibioticsSurgery was requiredPhysical therapy was required In your own words, describe how the cat behaved after the bite.: ============== Has your cat ever bitten or fought with another cat? YesNo Briefly describe the most three most recent incidents in which your cat bit another cat Do you have a dog or dogs? YesNo ABOUT DOG #1: Dog's name: What breed or breed mix is your dog?: How much does your dog weigh?: Dog's gender: MaleFemale Is the dog spayed or neutered?: YesNo What is your dog’s current age?: How old was your dog when you got him or her?: Where did you get your dog? BreederShelterRescue GroupFoundPrivate Adoption --- ABOUT DOG #2 (if applicable): Dog's name: What breed or breed mix is your dog?: How much does your dog weigh?: Dog's gender: MaleFemale Is the dog spayed or neutered?: YesNo What is your dog’s current age?: How old was your dog when you got him or her?: Where did you get your dog? BreederShelterRescue GroupFoundPrivate Adoption --- ABOUT DOG #3 (if applicable): Dog's name: What breed or breed mix is your dog?: How much does your dog weigh?: Dog's gender: MaleFemale Is the dog spayed or neutered?: YesNo What is your dog’s current age?: How old was your dog when you got him or her?: Where did you get your dog? BreederShelterRescue GroupFoundPrivate Adoption YOUR CAT'S EVERYDAY LIFE: How many people live with your cat? Ages of children who live with your cat Do children under the age of 16 ever visit your home? YesNo List other animals who live in your home Does your cat regularly and successfully play with other animals? YesNo What do you feed your cat? How do you feed? Food always availableBowl fed at set times What are your cat's favorite toys? Briefly describe a typical day in your cat's life. Include routines and daily exercise if any. HEALTH INFORMATION: Which veterinary clinic / hospital do you use? Which veterinarian do you usually see? List any medical conditions for which your cat is currently being treated. Do the medical conditions above (if any) cause frequent or chronic pain? YesNo List any medications your cat is currently taking other than heart worm or flea prevention. Are any of the above medications specifically prescribed for behavior issues? YesNo TRAINING HISTORY: How do you respond when your cat does something right? How do you respond when your cat does something wrong? List any tricks or behaviors you have taught your cat: FINAL QUESTIONS: How did you hear about Houston Cat Behavior? List all that apply.
