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Feline History Form

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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.

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

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

GROOMING

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

INTERACTIONS WITH OTHER HOUSEHOLD PETS

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

VETERINARY VISITS

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

PUNISHMENT

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

RESPONSE TO STRANGERS

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

RESPONSE TO UNFAMILIAR ANIMALS

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

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: Required

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: Required

Expectations

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