ࡱ>  <bjbj>> 4TT<,,,,\l,.baaaaaaa$dfRaaa aauY4` > [>aa0.b[.gg|`g`aa.bg : Feline Behavior History Form PET INFORMATION Name: _______________ Breed:_______________ Sex: M ( F ( Spayed ( Neutered ( Age:______ MEMBERS IN HOUSEHOLD Please list all family members currently living in the household NameRelationshipSexAgeRelationship with PetAre there children that interact with your cat (other than those listed above)? ( Yes ( No If yes, please describe.______________________________________________________________________________________ ________________________________________________________________________________________________________ Who is the primary caretaker of the cat in your household?_________________________________________________________ PETS IN HOUSEHOLD Please list all other pets currently living in the household. NameSpeciesBreedSexAgeDo all the pets in your household get along with each other and interact well? ( Yes ( No If Yes, please describe.________________________________________________________________________________________ __________________________________________________________________________________________________________ Are any pets kept apart due to aggression? ( Yes ( No If yes, which pets?_________________________________________________________________________________________ For how long are pets kept apart?_____________________________________________________________________________ Please describe.___________________________________________________________________________________________ PET HISTORY Where did you get your cat?__________________________________________________________________________________ At what age?__________ At what age was your pet spayed/neutered?__________ Is your cat declawed? ( Yes ( No If yes, is the cat front declawed or all four declawed? ( Front paws ( All four paws Did you meet the parents of your cat? ( Yes ( No If you met the mother, how would you describe her temperament (check all that apply)? ( Quiet ( Calm ( Excitable ( Unruly ( Bold ( Confident ( Shy ( Fearful ( Aggressive ( Other________ If you met the father, how would you describe his temperament (check all that apply)? ( Quiet ( Calm ( Excitable ( Unruly ( Bold ( Confident ( Shy ( Fearful ( Aggressive ( Other________ Do your cats parents/littermates show similar behaviors as your cat? ( Yes ( No (Unknown (Other______________ For what purpose did you obtain your cat? (check all that apply) ( Companion ( Competition/Show ( Farm/Mousing ( Breeding ( Other_____________________________________ If your obtained your cat as a kitten, please answer the following: How was it raised prior to your home? (check all that apply) ( Indoors ( Outdoors ( Kennel ( Garage ( Pet Store ( Unknown ( N/A ( Other_________________________ How did you select your kitten? (check all that apply) ( Breeder selected ( No choice ( Outgoing ( Timid ( Size ( Markings ( Conformation ( Sex ( N/A ( Other_________________________________________________________________________________________________ Did your kitten (<2 mon old) have any early illness? ( Yes ( No If yes, please describe:______________________________________________________________________________________ Has your cat had previous owners? ( Yes ( No ( Unknown If yes, please answer the following: How many?_________________ If known, why was the cat relinquished?_______________________________________________________________________ For what purpose was the cat owned? (check all that apply) ( Companion ( Competition/Show ( Farm/Mousing ( Breeding ( Other___________________________________ MEDICAL HISTORY Is your cat routinely taking a Heartworm preventative? ( Yes ( No If yes, what brand?___________________________ Is your cat routinely taking a flea/tick preventative? ( Yes ( No If yes, what brand?___________________________ Has your cat ever had a seizure? ( Yes ( No If yes, how often do they occur?______________________________________________________________________________ Does your cat have a history of allergies? (indoor/outdoor/food/fleas, etc) ( Yes ( No If yes, to what?____________________________________________________________________________________________ Does your cat have arthritis or other pain related conditions? ( Yes ( No If yes, please explain._______________________________________________________________________________________ Does your cat have a sensitive stomach or a history of hairballs, vomiting and/or diarrhea? ( Yes ( No If yes, please explain._______________________________________________________________________________________ How often does your cat defecate?___________ Is the stool: ( Normal ( Hard ( Soft ( Diarrhea How often does your cat urinate?____________ Is the urine: ( Normal ( Excessive volume/frequency ( Infrequent ( Abnormal Does your cat have a history of urinary crystals or bladderstones? ( Yes ( No If yes, which?________________________ Has your cat ever had a urinary obstruction? ( Yes ( No If yes, please describe.______________________________________________________________________________________ Date of last Rabies Vaccine? ____/____/____ Has your cat recently had any diagnostic tests? (check all that apply) ( Physical Exam ( Bloodwork ( Urinalysis ( Radiographs/Ultrasound/CT/MRI ( Unknown ( Other___________________________________________________________________________________________________ Does your cat have any current medical problem(s)? ( Yes ( No If yes, please explain?______________________________________________________________________________________ Please list all medication and supplement your cat is currently taking. Medication/SupplementStrength (mg or ml)How givenFrequencyFor what purpose HOUSING/LIFESTYLE How would you describe your cats lifestyle? ( Indoor only ( Indoor/Outdoor ( Outdoor only On average, how many hours a day is your cat indoors?__________ On average, how many hours a day is your cat outdoors?__________ On average, how many hours is your cat left home alone? During the week?__________ During the weekend?__________ What is your schedule like: During the week? ( Consistent ( Varies During the weekend? ( Consistent ( Varies Where is the cat when left home alone during the day? (check all that apply) ( Crate/kennel ( Confined in a room ( Loose in the home ( Basement/Garage ( Indoor/Outdoor ( Outdoors ( N/A ( Other___________________________________________________________________________________________ Where is the cat when left home alone during the night? (check all that apply) ( Crate/kennel ( Confined in a room ( Loose in the home ( Basement/Garage ( Indoor/Outdoor ( Outdoors ( N/A ( Other___________________________________________________________________________________________ Does the cat sleep in a persons bedroom? ( Yes ( No If yes, whose bedroom?_________________________________ Is the cat allowed to sleep on that persons bed? ( Yes ( No Are any of the pets managed separately or kept in separate living areas? ( Yes ( No If yes, which pets?_________________________________________________________________________________________ Why?____________________________________________________________________________________________________ Do you feed feral or stray cats around your home or neighborhood? ( Yes ( No If yes, how many?_____________________ DIET What brand of food do you feed your cat?______________________________ How much per day (cups) do you feed your cat?_________________________ How often do you feed your cat? ( Once daily ( Twice daily ( Three times daily ( Free fed ( Other_______________ How would you describe your cats feeding schedule? ( Consistent ( Varies Who feeds the cat?__________________________________________________________________________________________ How would you describe your cats appetite? ( Ravenous ( Good ( Average ( Poor ( Picky ( Very picky Do you offer treats? ( Yes ( No If yes, are treats contingent on behavior? ( Yes ( No What is your cats favorite treat?_______________________________________________________________________________ Is fresh water available at all times? ( Yes ( No Is water ever restricted? ( Yes ( No If yes, when and for how long?___________________________________________ How would you describe your cats watering schedule? ( Consistent ( Varies How many food bowls are there available in the home?__________ How many water bowls are there available in the home?__________ LITTER BOXES/HYGIENE How many litter boxes do you have in total in your home?_______ How many cats in total are living in your home?________ Where are the litter boxes located? (check all that apply) ( Living area ( Spare room ( Basement ( Kitchen ( Closet ( Bathroom ( Hallway ( Laundry room ( Other___________________________________________________________________________________________________ What type(s) of litter boxes do you have? (check all that apply) ( Open ( Covered ( Self-cleaning ( Other________________________________________________________________ What type(s) of litter do you use? (check all that apply) ( Clumping ( Clay ( Wood pellets/shavings ( Crystals ( Newspaper ( Sand ( Other______________________ Is the litter ( Deodorized/Scented ( No odor control ( Unknown Do you always use the same type of litter or does it vary? ( Consistent ( Varies Do you use plastic liners? ( Always ( Sometimes ( No How often are the litter boxes scooped? (check only one) ( More than once daily ( Daily ( Several times a week ( Weekly ( Monthly ( Less than once monthly ( N/A How often are the litter boxes washed? (check only one) ( Daily ( Several times a week ( Weekly ( Monthly ( Less than once monthly ( N/A What type of cleaner do you use? (check all that apply) ( Strong disinfectant ( Scented cleaner (lemon, pine, etc) ( Bleach ( Mild soap ( Water only ( Other_________ If the cats urinate/defecate outside of the litter box, with what do you clean the soiled area?_______________________________ __________________________________________________________________________________________________________ TRAINING/PLAY What sort of commands does your cat respond to? (check all that apply) ( Doesnt know any ( Come ( Fetch ( Sit ( Stay ( Other_______________________________________________ How often do you train or play with your cat? (check all that apply) ( Less than once weekly ( Weekly ( Several times per week ( Daily ( More than once daily ( N/A Please describe how you play with your cat.______________________________________________________________________ What is your cats favorite toy?_________________________________________________________________________________ In what way(s) do you discipline your cat? (check all that apply) ( I dont ( Verbal reprimand ( Physical reprimand ( Noise to startle ( Response substitution ( Time out ( Water bottle ( Scruff ( Other__________________________________________________________________________ For what behavior(s) does your cat require discipline? (be specific)__________________________________________________ ________________________________________________________________________________________________________ Have you ever used a trainer/veterinarian/behavior specialist to address your pets behavior/training problems? ( Yes ( No If yes, who?_______________________________________________________________________________________________ For what problem(s)?_______________________________________________________________________________________ TEMPERAMENT How would you most accurately describe your cats personality? (check all that apply) ( Friendly towards familiar people (family members) ( Friendly towards unfamiliar people (strangers) ( Aggressive towards familiar people (family members) ( Aggressive towards unfamiliar people (strangers) ( Aggress towards unfamiliar people on my property ( Aggressive towards unfamiliar people off my property ( Aggressive when meeting unfamiliar dogs (on a walk) ( Aggressive towards familiar dogs in my home (housemates) ( Hyper/excitable ( Happy/outgoing ( Shy/inhibited ( Aloof ( Fearful/shy (people) ( Fearful (objects/environment) ( Fearful (sounds/noises) ( Fearful (dogs) Comments:___________________________________________________________________________________________________________________________________________________________________________________________________________ When he/she was a kitten (< 4 mon old), was their personality different in any way? ( Yes ( No If yes, please describe.______________________________________________________________________________________ ________________________________________________________________________________________________________ How would you best describe your cats activity level? (check only one) ( Low ( Average ( High ( Hyperactive Does your cat, on a regular basis, do any of the following behaviors: (check all that apply) YesIn your presence (times per week)In your absence (times per week)NoUnknownExcessive vocalization(( (__________)( (__________)((House soiling (urine/feces)(( (__________)( (__________)((Excessive self-grooming(( (__________)( (__________)((Destructive chewing(( (__________)( (__________)((Destructive scratching(( (__________)( (__________)((Repetitive behavior(( (__________)( (__________)((Garbage raiding/food stealing(( (__________)( (__________)((Predation(( (__________)( (__________)((Climbs on furniture/off-limit areas(( (__________)( (__________)((Mounting/roaming/masturbation(( (__________)( (__________)((Climbs inappropriate objects(( (__________)( (__________)(( AGGRESSION HISTORY Has your cat ever displayed aggression towards a person? ( Yes ( No If yes, how many times has it occurred?________________________________________________________________________ If yes, what level best characterizes the most significant incident of aggression towards a person? (check only one) ( Level 1: Harassment, hissing, swatting, defensive. Cat did not make contact or touch skin. ( Level 2: Hissing, swatting, defensive. Teeth/claws made contact with skin without punctures or deep scratches. ( Level 3: 1-4 punctures from a single bite. Punctures and deep scratches occurred. ( Level 4: 1-4 punctures from a single bite. Cat held the bite, grabbed and held with mouth/claws/paws. ( Level 5: Multiple level 3/level 4 bites from a single incident. Offensive. ( Level 6: Bite resulting in fatality/death Has your cat ever bitten a person? ( Yes ( No If yes, how many times has a bite occurred?____________________________________________________________________ If yes, how many incidents were Level 3+?______________________________________________________________________ If yes, how many incidents were reported to public health authorities?_______________________________________________ How does your cat react in the following situations? (check only one please choose the most appropriate/worst case) CalmFriendlyHyperNeutralFearfulAggressiveAnxiousUnknownUnfamiliar people in the home((((((((Unfamiliar people approach the cat((((((((Unfamiliar people pet the cat((((((((Babies (< 1 yr of age)((((((((Children, 1-6yrs((((((((Children, 7-11yrs((((((((Children, 12-18yrs((((((((Unfamiliar cat in the home((((((((Unfamiliar dog in the home((((((((Familiar cat in the home approaches((((((((Familiar dog in the home approaches((((((((Out the window Sees a cat((((((((Out the window Sees a dog((((((((Out the window Sees a squirrel or bird((((((((Family member Approaching the cat((((((((Family member Petting the cat((((((((Family member Disturbing sleeping cat ((((((((Family member Lifting cat up((((((((Family member Restraining cat((((((((Family member Grooming((((((((Family member Nail trimming((((((((Family member Giving medicine (pill)((((((((Family member Giving medicine (liquid)((((((((Placing cat in carrier((((((((Rough play with hands((((((((Vet Clinic Exam room((((((((Loud noises((((((((Vacuum cleaner or broom(((((((( Are there other objects or environments to which your cat is fearful or afraid? ( Yes ( No ( Unknown Please list all things (objects, environment, people, etc) that trigger a fear response.______________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________ PLEASE LIST BRIEFLY THE PROBLEMS/COMPLAINTS IN ORDER OF IMPORTANCE: (Problem 1 most important, Problem 4 least important) EXAMPLES OF SOME COMMON PROBLEMS Aggression towards family members in the home Aggression towards familiar animals in the home Aggression towards unfamiliar people on the property Aggression towards unfamiliar animals on the property Fear towards familiar people Fear towards unfamiliar people Fear towards familiar animals Fear towards unfamiliar animals Fear towards sounds Fear towards objects or environment Generally nervous/anxious Excessive vocalization Destructive behavior House soiling (urine and/or stool in inappropriate location) Unruly or unwanted behavior (mounting, jumping on people, pulling on the leash, etc) Excessive repetitive behavior (tail chasing, circling, fly snapping, staring, chasing light/shadows, etc) Separation anxiety In cases of aggression, please describe between the trigger of the aggression, the target of aggression, the dogs familiarity with the target of aggression, and where the case of aggression took place. Problem 1:_________________________________________________________________________________________________ Problem 2:_________________________________________________________________________________________________ Problem 3:_________________________________________________________________________________________________ Problem 4:_________________________________________________________________________________________________ Please complete the following pages to describe in detail each individual problem. Please fill out a separate page for each problem. PROBLEM HISTORY PROBLEM 1 Describe in detail a typical behavioral incident. Please include in each description the following information: What happens? Where does it happen? Who is present? What triggers the incident? How does the cat behave before the incident (body language) and after the incident? How do people react to the cat before and after the incident? Describe the most recent incident (date _____/_____/_____).________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Describe the 2nd most recent incident (date _____/_____/_____).____________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Describe the 3rd most recent incident (date _____/_____/_____).____________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Describe the earliest incident (date _____/_____/_____).___________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Age that this problem started?__________________ Where there any changes in the home environment around the time of the earliest incident? ( Yes ( No ( Unknown If yes, what?______________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________ What has been the progress of this behavior problem? (check only one) ( Increasing ( Decreasing ( No change What is the frequency of the behavior problem? (check only one) ( >10x/day ( 1-10x/day ( 1-6x/wk ( <1x/wk Please describe any training or behavioral techniques that you have tried for this behavior problem._________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________ Please list any current or previously used medications prescribed specifically for this behavior problem. MedicationStrength (mg or ml)How givenFrequencyEffectDuration of UseFor each medication listed above, please describe any negative or undesirable side effects?________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ PROBLEM 2 Describe in detail a typical behavioral incident. Please include in each description the following information: What happens? Where does it happen? Who is present? What triggers the incident? How does the cat behave before the incident (body language) and after the incident? How do people react to the cat before and after the incident? Describe the most recent incident (date _____/_____/_____).________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Describe the 2nd most recent incident (date _____/_____/_____).____________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Describe the 3rd most recent incident (date _____/_____/_____).____________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Describe the earliest incident (date _____/_____/_____).___________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Age that this problem started?__________________ Where there any changes in the home environment around the time of the earliest incident? ( Yes ( No ( Unknown If yes, what?______________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________ What has been the progress of this behavior problem? (check only one) ( Increasing ( Decreasing ( No change What is the frequency of the behavior problem? (check only one) ( >10x/day ( 1-10x/day ( 1-6x/wk ( <1x/wk Please describe any training or behavioral techniques that you have tried for this behavior problem._________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________ Please list any current or previously used medications prescribed specifically for this behavior problem. MedicationStrength (mg or ml)How givenFrequencyEffectDuration of UseFor each medication listed above, please describe any negative or undesirable side effects?________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ PROBLEM 3 Describe in detail a typical behavioral incident. Please include in each description the following information: What happens? Where does it happen? Who is present? What triggers the incident? How does the cat behave before the incident (body language) and after the incident? How do people react to the cat before and after the incident? Describe the most recent incident (date _____/_____/_____).________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Describe the 2nd most recent incident (date _____/_____/_____).____________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Describe the 3rd most recent incident (date _____/_____/_____).____________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Describe the earliest incident (date _____/_____/_____).___________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Age that this problem started?__________________ Where there any changes in the home environment around the time of the earliest incident? ( Yes ( No ( Unknown If yes, what?______________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________ What has been the progress of this behavior problem? (check only one) ( Increasing ( Decreasing ( No change What is the frequency of the behavior problem? (check only one) ( >10x/day ( 1-10x/day ( 1-6x/wk ( <1x/wk Please describe any training or behavioral techniques that you have tried for this behavior problem._________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________ Please list any current or previously used medications prescribed specifically for this behavior problem. MedicationStrength (mg or ml)How givenFrequencyEffectDuration of UseFor each medication listed above, please describe any negative or undesirable side effects?________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ PROBLEM 4 Describe in detail a typical behavioral incident. Please include in each description the following information: What happens? Where does it happen? Who is present? What triggers the incident? How does the cat behave before the incident (body language) and after the incident? How do people react to the cat before and after the incident? Describe the most recent incident (date _____/_____/_____).________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Describe the 2nd most recent incident (date _____/_____/_____).____________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Describe the 3rd most recent incident (date _____/_____/_____).____________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Describe the earliest incident (date _____/_____/_____).___________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Age that this problem started?__________________ Where there any changes in the home environment around the time of the earliest incident? 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