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.

General Information

* Indicates required field

Who is your regular veterinarian:

Behavior Problem


  1. Behavior ProblemSeverity
  2. Describe several examples in detail: When, where and what other animals or people were present.
    1. ( )
    2. ( )
    3. ( )

Elimination Behavior

    1. ( )

Cat's Background









Diet and Feeding

Home Environment








Daily Schedule


Social Behavior





Sexual Behavior

Grooming

  1. ?

Medical History

Seriousness






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