Cat Behavior History Form

Cat Behavior History Form
Person Information
Primary Caregiver Full Name*
First NameLast Name
Please select one or more options for the set(s) of pronouns you want people to use to refer to you:
she, her, hershe, him, histhey, them, theirsOther
Email*
Phone Number
Please enter a valid phone number.
Name of other owner/caregiver/foster(s)
First NameLast Name
Other Email
example@example.com
Other Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Pet Information
Cat's Name*
Breed or mix*
Color(s)
Current Age*
What is the sex of this cat?*
MaleFemaleUnsure
Is this cat spayed or neutered?
YesNoUnsure
Is this cat declawed?*
NoFront onlyAll four paws
How old was the cat when they were declawed?
Is this cat microchipped?*
YesNoUnsure
Microchip number if known
Where did you get this pet?*
What do you know about this pet's history?*
How long has this pet lived with you?*
Family Make Up
Describes all HUMANS in this cat's life*
Name Age Pronouns Relationship (live together, visit frequently, recently left/passed, get along, conflict, etc.)
1
2
3
4
Describes all ANIMALS in this cat's life
Name Age Species (cat, dog, bird, other) Relationship (live together, visit frequently, recently left/passed, get along, conflict, etc)
1
2
3
4
Is your cat having issues with another pet in your home?
Yes, one other petYes, Multiple other petsNo
Describe the other pet involved
Describe another pet involved (if relevant)
Describe another pet involved (if relevant)
Have there been any recent changes in your pet's life (new pet or human family member, moving, renovation, etc.)?*
YesNo
Please describe the recent change(s)
The Behaviors
Describe the behavior you most want to address*
Is there anything else you think is important to share about this behavior?
Do you have other behaviors you want to address?
YesNo
Describe the second most important behavior you want to address*
Describe any other concerning behaviors (list in order of priority)
Are you prepared that it may take time to resolve this behavior issue, which may be up to several months or more? *
Training History
How do you typically reward good behavior? (check all that apply)*
PettingVerbal praiseTreats/foodToys/playI don't knowOther
How do you typically correct unwanted/bad behavior? (check all that apply)*
Physical (Spanking, nose tap, etc)Verbal (Scold, No!, AhhAhh!, Tsst!, etc)Noise (Squirt bottle, penny can, clap hands, etc)I don'tOther
Please list any professionals you have discussed your concerns with.
What have you specifically tried to resolve the problems in the past?*
How did the pet respond to what you described above?*
Got worseGot betterNo changeUncertainOther
Health, Nutrition, Exercise
Cat's typical exercise on an average day*
Does cat go outside*
NoAt scheduled times, comes in at nightIn/out wheneverOther
Has this cat been to a veterinarian while in your care?*
YesNo
Please provide the name and phone number or email of the vet that examined your pet.
Have you discussed your concerns with your vet?
YesNo
What recommendations did your vet give you?
Date of most recent vet exam and notable comments
List any current, recent, or past injuries or illnesses*
List medications, supplements, etc. *
List any food sensitivities or allergies
What brand(s) of food do you feed?
Describe this cat's feeding (Check all that apply)
Raw or homemade all day/free choiceRaw or homemade fed by scheduleDry available all day/free choiceDry fed by scheduleCanned available all day/free choiceCanned fed by scheduleOther
How does this cat access water? (check all that apply)
BowlFountaincleaned dailycleaned weeklycleaned rarelyOther
Please submit any other relevant records
Cancelof
Litter Box Details
Is your cat urinating outside of the box?*
YesNo
When did your cat start urinating outside the box?
When was the most recent occurrence of urinating outside the box?
How often is your cat urinating outside the box?
At least dailyAt least weeklyAt least monthlyRarelyOther
Is your cat currently experiencing any of the following urinary signs (check all that apply):
Vocalizing while urinatingProducing small, frequent puddles of urineStraining to urinate with little urine producedDribbling urinePink or red colored urineNone of the above
* Note: male cats straining to urinate, seeming depressed/lethargic, and/or unable to produce urine should be seen urgently at a community veterinary practice or emergency room to rule out a potentially life-threatening condition called urethral obstruction.
Does the urinating outside the litter box tend to occur at a certain time of day or under certain circumstances? If yes, please describe.
Have you noticed anything that has increased or decreased the urinating outside the litter box? If yes, please describe.
Where does your cat urinate when they urinate outside the litter box? For example, near the litterbox, near an exterior door, in the bedroom, consistently in the same place versus all over the house...
How would you describe the urination? (check all that apply)
Large urine puddles on flat or horizontal surfaceSmall urine puddles on flat or horizontal surfaceUrine on vertical surfaces, such as wallsUrine is dark in color, smells funny or strong, etc.Other
What materials is the cat urinating on? (check all that apply)
In litter boxSoft flooring (carpet, area rugs, etc.)Hard flooring (hardwood, tile, linoleum, etc.)ClothingTub or sinkPet beddingHuman beddingFurnitureNew items in the homeItems belonging specifically to one personOther
Most recent urinalysis and results
Is your cat defecating outside of the litter box?*
YesNo
When did your cat start defecating outside of the litter box?
When was the most recent occurrence of defecating outside of the litter box?
How often is your cat defecating outside of the litter box?
At least dailyAt least weeklyAt least monthlyRarelyOther
Does the defecating outside the litter box tend to occur at a certain time of day or under certain circumstances? If yes, please describe.
Have you noticed anything that has increased or decreased the defecating outside the litter box? If yes, please describe.
Where does your cat defecate when defecating outside the litter box? For example, near the litterbox, near an exterior door, in the bedroom, consistently in the same place versus all over the house...
How would you describe the feces? (check all that apply)
Feces is liquid (has no shape, makes puddles)Feces is soft (like soft serve ice cream)Feces is firm, moist (like a soft Tootsie Roll)Feces is hard, dry (like an old Tootsie Roll)Other
What materials is the cat defecating on? (check all that apply)
In litter boxSoft flooring (carpet, area rugs, etc.)Hard flooring (hardwood, tile, linoleum, etc.)ClothingTub or sinkPet beddingHuman beddingFurnitureNew items in the homeItems belonging specifically to one personOther
If you have ever had a fecal sample for your cat tested by the vet, when was that most recently completed and do that and what were the results?
If you have ever had other relevant testing (e.g. x-rays, imaging, bloodwork) done by the vet, when was that most recently completed and what were the results?
Describe your litter boxes
Location Height of lowest side Length/ width Other details (e.g. covered vs. uncovered, automatic/self-cleaning)
Box 1
Box 2
Box 3
Box 4
What is the behavior of your cat while using the litterbox? Select all that apply
Stands with all four paws in the boxStands with only back paws in the boxStands on the edge, tries not to touch litterAlways covers urine/fecesRarely covers urine/fecesScratches at the wall, sides of box, or floor while coveringAlways looking out for other cats (may run if they come near)Urinates in one box and defecates in anotherVocalizesNever uses the litterboxOther
How often do you scoop?
Multiple times per dayOnce dailyA few times a weekWeeklyLess than weeklyOther
How often do you completely empty the litterbox(es), wash them, and put in fresh litter?
At least weeklyA few times a monthAround once a month or moreOther
What type of litter do you currently use? Please include whether it is clumping or non-clumping, scented or non-scented, and the material - e.g. clay, pine, paper, crystal, corn, wheat, pee pads, etc. Please note if your cat has a preferred litter type.
If you have tried other litter types in the past, please list the type, how long you used it for, and whether your cat used it.
What steps have been taken to resolve the house-soiling? (check all that apply)
Changed location of boxChanged type of litterConfined cat to smaller space with their litterboxAdditives to litter (baking soda, etc.)Put food dishes in accident areaPunishmentMedicationUsed synthetic pheromone spray or diffuser in area (e.g. Feliway)Covered incident area to make it undesirable (e.g. sticky tape, foil, nubby mats, etc.)Changed type of litter boxCleaned box more frequentlyAdded another litter boxOther
Please describe the methods of punishment you use when your pet eliminates outside the litter box.
Please give the names and doses of medications you've tried for resolving house-soiling, as well as how long you tried them and if your pet is currently on them.
What were the results of your attempts to resolve the house-soiling?
What method/product(s) do you use to clean accident areas?
What other comments do you have about this cat's litterbox behavior?
Destructive Scratching Details
Is your cat scratching your belongings?*
Yes and I want it to stopYes but I don't careNo
Describe your scratching posts (check all that apply)
Have noneHave 1Have 2-3Have 4+Sisel ropeCardboardCarpetHangs or stands upright/verticallyLies flat/horizontally on the floorCat uses it regularlyCat uses it sometimesCat rarely or never uses itIs sturdy and doesn't move when cat scratches itWobbles, swings, or otherwise moves during scratchingOther
What kinds of surfaces are being scratched that you don't like?
Couch, chair, human bed, or other furnitureCarpet or throw rugsWoodwork, posts, or railsWalls, wallpaperWindow screensFabricLeatherWoodOther
Describe nail care (check all that apply)
No nail careNail clippersNail grinderTrimmed weeklyTrimmed monthlyTrimmed occasionallyI trimVet trimsGroomer trimsSedation neededRestraint neededOther
What is being scratched that you don't like? (check all that apply)
Couch, chair, furnitureLeatherUpholsteryFabricCarpet / rugWoodwork, posts, railsWalls, wallpaperWindow screensOther
Aggression Information
Is your cat displaying aggression (hiss, growl, swat, etc.)?*
YesNo
How many aggressive incidents have occurred?
When did the aggression start?
Date of most recent aggressive incident
MonthDayYear
Date
Describe the aggression (check all that apply)
HissGrowlSnapped only, no contactSwat, no contactSwat, contact but no broken skinShallow scrape/scratch from clawsSwat, deep scratchOne or a few scratches that don't or barely bleedOne or a few scratches that bleedMultiple scratches that bleedBite, contact but no broken skinBite, bleedingBite, medical care neededMultiple bites in a single eventOther
Who is the aggression directed toward? (check all that apply)
Directed toward adultDirected toward childDirected toward catDirected toward dogVictim is a member of the householdVictim is familiar to cat, but not living in same householdVictim is a strangerOther
What age(s) are the child(ren) who were attacked?
What was the victim doing before the aggression occurred?
Where was the victim in relation to the cat?
Did the cat lunge/jump/move toward the victim?
YesNoUnsure
When is the aggression occurring (check all that apply)
During pettingDuring handling or restraintWhen walking pastAround food timeRandomlyIn homeOutdoorsAt vet, groomer, etc.During playWhen someone gets too closeOther
Is the cat exhibiting any warning signs prior to aggression? (check all that apply)
RetreatingTurning away/avoidingGrowlingTwitching tailSnappingFur standing upEyes dilatedNoneOther
Describe instances of aggression
Details of the most severe incident*
Is there anything more you'd like to share? Provide any additional behaviors and/or information.
Should be Empty:

	Name	Age	Pronouns	Relationship (live together, visit frequently, recently left/passed, get along, conflict, etc.)
1
2
3
4

	Name	Age	Species (cat, dog, bird, other)	Relationship (live together, visit frequently, recently left/passed, get along, conflict, etc)
1
2
3
4

	Location	Height of lowest side	Length/ width	Other details (e.g. covered vs. uncovered, automatic/self-cleaning)
Box 1
Box 2
Box 3
Box 4