Feline Behavior History Form

Animal Behavior Consultants of Northern Michigan
Dr. Katherine A. Houpt
Phone: (989) 448-8083
web: http://abcofnm.com
email: kah@abcofnm.com

Please answer the following questions and submit this form. We shall then call to arrange an appointment. Specific questions about the problem behavior(s) will be asked during your visit/telephone call.

Behavior Problem

1. What is the main behavior problem or complaint?
2. Please list other behavior problems.
   

   Behavior Problem	Severity
   	Very Serious Serious Not Serious
   	Very Serious Serious Not Serious
   	Very Serious Serious Not Serious

3. When did you first notice the main problem (age of cat)?
4. Describe the chronology of the behavior problem, i.e. how it developed over time:
5. When did it first become a serious concern?
6. In what general circumstances does the cat misbehave?
7. How frequently does the problem (or problems) occur (how many times daily, weekly or monthly):

   Problem:	Frequency:
   Problem:	Frequency:
   Problem:	Frequency:

8. Describe several examples in detail: When, where and what other animals or people were present.
   1. Most recent incident: (Date: )
   2. Second to last incident: (Date: )
   3. Third to last incident: (Date: )
9. Other significant incidents:
10. What have you done so far to try to correct the problem?
11. How do you discipline your cat for this problem?

Elimination Behavior

1. Does your cat use a litter pan? Yes No
2. How did you litter train your cat?
3. Does your cat ever eliminate in the house but outside the litter pan? Yes No
4. If yes, does your cat: urinate defecate both
5. How many litter pans do you have?
6. Where are they (please be specific: which room, which floor)?
7. What kind of pans are they (indicate number)?
   1. commercial litter pan (Size: )
   2. commercial litter pan with removable "lip"
   3. covered box, "cave"-type front door
   4. covered box, "Booda"-type (cat crawls into hole)
   5. dishpan
   6. cardboard box
   7. automatic litter box (LitterMaid, CatGenie
   8. other (please describe:)
8. How old is each pan?
9. Do you use a liner? Yes No
10. If yes, what type (plastic, newspaper, etc.)
11. What kind of litter is used (please be specific):
12. Have you recently changed brands?
13. How often is litter scooped?
14. How often is litter replaced?
15. How often do you wash the box(es), and how (please be specific)?
16. Does the cat cover urine in the box? Yes No
17. Does the cat cover feces in the box? Yes No

Cat's Background

1. Where did you get this cat:
   SPCA
   BREEDER - newspaper ad/flyer
   BREEDER - referral
   PET STORE
   FRIEND
   STRAY
   OTHER
2. Have you owned cats before? Yes No
3. How old was the cat when acquired?
4. If known: how many littermates?
   males female
5. How many animals to choose from?
6. Why did you decide to get a cat?
7. Why this particular breed, sex, color?
8. Why did you choose this cat over the others (please be specific):
9. Describe your cat's behavior as a kitten:
10. Has this cat had other owners? Yes No
11. If yes, how many?
12. If yes, why was the cat given up?
13. How long have you had this cat?

Diet and Feeding

1. What do you feed your cat? (Please be specific, e.g. brand name)
2. Has your cat's appetite (increased, decreased, no change)?
3. How much do you feed? (please be specific) How often and when is it fed? Where is he/she fed?
4. Where does your cat drink?
5. Who feeds the cat?
6. What is your cat's favorite treat?

Home Environment

1. Please list the people, including yourself, living in your household:
   Name, Hours away from home
2. Name, Hours away from home
3. Please list all animals in the household:
   Name, Species, Breed, Sex, Age Obtained, Age Now In what sequence were the above animals obtained? (Please number animals in the table above).
4. What is your cat's relationship to the other animals (e.g. friendly, hostile, fearful)? Please describe:
5. What type of area do you live in? CITY SUBURBS RURAL
6. What type of house do you live in?
   APARTMENT - STUDIO OR 1 BEDROOM
   APARTMENT - 2 + BEDROOMS
   DUPLEX/ATTACHED HOUSE
   HOUSE - SINGLE FAMILY
   TRAILER
   FARM
   OTHER
7. Have you moved since acquiring your cat? Yes No
8. If yes, how many times?
9. Has your household (people or animals) changed since acquiring your cat? Yes No
10. If yes, please describe:

Daily Schedule

1. How do you play with your cat?
2. Does your cat go outdoors? Yes No
3. Is your cat supervised when outdoors? Yes No
4. How does your cat signal to go outside?
5. Does your cat use a pet door? Yes No
6. Do you have an invisible fense? Yes No
7. Is your cat harness/leash trained? Yes No
8. What percentage of time does your cat spend outdoors or indoors?
   % indoors % outdoors

Social Behavior

1. Where does your cat sleep at night (please be specific):
2. Where is your cat when you have guests?
3. How does your cat behave with adult visitors?
4. How does your cat behave with visiting children?
5. How does your cat behave with the veterinarian?
6. How does your cat behave when you return?
7. How does your cat respond to cats seen out of the window or in the yard?
8. When does the cat meow?
9. When does the cat hiss or growl?
10. What toys does the cat have?
11. Does your cat carry toys/objects or "mother" other animals? Yes No
12. What is your cat's activity level in general:
    LOW
    AVERAGE
    HIGH
    EXCESSIVE
13. How would you describe your cat's personality?

Sexual Behavior

1. At what age was your cat neutered/spayed?
2. Why was this done?
3. Were there any behavior changes after neutering?
4. Does your cat mount other cats? Yes No
5. Animals? Yes No
6. People? Yes No
7. Inanimate objects? Yes No
8. If yes, who or what is mounted?
9. If your cat is "intact" has he/she ever been bred? Yes No
10. If you have a female, was she a good mother? Yes No
11. Are you planning to breed your cat in the future? Yes No

Grooming

1. Does your cat groom, lick or bite himself excessively? Yes No
2. Does the cat's skin ripple? Yes No
3. Is your cat declawed? Yes No
4. If yes, declawed in the front only all four paws ?
5. What was the immediate aftercare (e.g. did you shred newspaper into the litter pan?)
6. Did your cat use this litter?
7. Did the paws become infected after the surgery? Yes No
8. Does your cat use a scratching post or favorite scratching area? (please describe)

Medical History

1. Is your cat on any medication now?
2. Has your cat been on medication in the past?

Seriousness

How serious is the behavior problem. Check the most appropriate response:
I am here only out of curiosity - problem is not serious.
I would like to change the problem, but it is not serious.
The problem is serious and I would like to change it, but if it remains unchanged that's all right.
The problem is very serious and I would like to change it, but if it remains unchanged I will keep my cat.
The problem is very serious and I would like to change it; if it remains unchanged I will have my cat euthanized or give him/her up.

Any Additional Comments

(End of questionnaire, please submit - thank you!)

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