top of page

Success!

Feline History Form

Create an account and log-in to be able to save your progress by clicking the "Save Progress" button.

Client Information

Cat Information

Veterinarian Information

Who is your regular veterinarian?

Behavioral Information

Severity
a. Severity
a. Severity

Home Environment

Please list the people, including yourself, living in your household. Also, please briefly describe the way each person interacts with the cat and how the cat reacts to this person:

Please list all animals in the household including the patient, in the sequence in which they were obtained.

​

Also, briefly describe the nature of the cat’s interaction with this pet (e.g. occasional growls, little interaction, friendly, etc)

Background Information

Feline Behavior History

FEARS AND ANXIETIES

Cat is home with family
Cat is alone at home or separated from family
Visitor enters home
Visitor approaches/ interacts with cat
Another household cat approaches
Household dog approaches
At veterinary office
At groomer’s
Owner is cleaning/ decorating/renovating
New object is in the home
Loud noises
Unfamiliar animal approaches

AGGRESSION SCREEN FOR CATS

The following chart provides information about aggression, its intensity, and in what situations it is elicited. For each situation listed, check your cat’s worst reaction in the past. These questions refer to situations in the past. Please do not do these things to determine your cat’s reaction. If he or she has never been in a particular situation, please check “situation does not apply”. Please indicate the target of aggression (e.g. person or animal) for the appropriate situation.

GENERAL INTERACTIONS

Family member stares at cat
Family member reaches toward or bends over cat
Family member pets cat on head or neck
Family member pets cat on back or belly
Family member hugs/kisses cat
Family member lifts cat
Family member approaches cat while resting
Family member pushes/pulls cat (e.g., off furniture)
Family member enters or leaves room cat is in
Family member approaches/disturbs cat while eating

GROOMING

Cat’s ears or eyes are cleaned or treated
Cat’s nails are trimmed
Cat is brushed/combed

INTERACTIONS WITH OTHER HOUSEHOLD PETS

Dog approaches cat while eating
Another cat approaches cat while eating
Cat encounters other cat near the litter box
Another cat approaches/disturbs cat while resting
Dog approaches/disturbs cat while resting
Cat approaches another household cat who is resting
Cat approaches another household cat who is eating

VETERINARY VISITS

Cat is in the waiting room
Veterinarian/staff member handles/examines cat
Cat is removed from or put back in carrier

PUNISHMENT

Cat is verbally scolded or yelled at
Cat is physically punished (hit)
Cat is sprayed with water or hit with thrown object

RESPONSE TO STRANGERS

Unfamiliar person (adult) approaches cat
Unfamiliar person (adult) speaks to/pets cat
Unfamiliar child approaches or interacts with cat
Response to infants or toddlers with cat
Unfamiliar person approaches/passes window while cat is indoors

RESPONSE TO UNFAMILIAR ANIMALS

Unfamiliar cat approaches/passes window while cat is indoors
Unfamiliar cat approaches/interacts with cat outside
Unfamiliar dog approaches/passes window while cat is indoors

Please describe the first and two most recent incidents in detail. Include date, people and animals present, location, trigger (e.g. visitor knocking on door), sequence of events leading to incident, how long the episode lasted, how you and target of any aggression reacted, and how quickly the cat returned to normal behavior (use back or separate page if necessary)

Environment

Daily Schedule

Is your cat:

Elimination Behavior

For each type of litter box you have, please indicate if you use a liner in that box, the approximate size of the box, location of box in your home, and brand name of the litter in each box.

Opened-top Commercial Litter Box
Covered box, “cave”-type front door
Covered box, “Booda”-type (cat crawls into hole on top of box)
Automatic cleaning

If your cat is eliminating outside of the litter box, please draw a simple outline of your home’s floor plan. Mark doors, windows, food bowls, human beds, cat sleeping locations, litter box locations, and locations where cat is eliminating outside of box. Please upload the photo here.

Choose File

Diet and Feeding

Medical History

MEDICAL PROBLEMS

Please list any previously diagnosed medical problems and how they were treated.

BEHAVIORAL MEDICATIONS AND SUPPLEMENTS

Please list any BEHAVIORAL medications and supplements you have administered to your pet:

Miscellaneous

Please check the statement that best describes how you are feeling about your cat’s behavior problem:

Expectations

An error occurred. Try again later

bottom of page