Feline Behavior History
Tidewater Trail Animal Hospital                                                                                           10839 Tidewater Trail                                                                                            Fredericksburg, VA 22408                                                                                                     540-361-7050                                                                                                                              Dr. Andi Lindamood                                                                                           andilindamood@gmail.com
General Information:
Date:____________
Person completing form (if not owner): _________________________
Client's name: ______________________  Cat's name: ___________________
Address: __________________________  Breed: _______________________
	   __________________________  Date of Birth: ________________
          ________________________   Gender:  M/F neutered/spayed: _____
Phone numbers: C:________ H: ________ email: ____________________________
Who is your regular veterinarian?   TTAH/ other
Veterinarian: ___________________________
Hospital name: __________________________
Phone number: __________________________
What is the main behavior concern?

Please list additional problems:

How frequently do the problem(s) occur (How many times daily, weekly, monthly)
a.	Main Concern _______________________ frequency ________________
b.	Concern 2 __________________________ frequency _________________
c.	Concern 3 __________________________ frequency_________________
Chronology of Behavior Concern:
When did you first notice the main problem?  (age of cat)

Describe how this behavior developed over time:

When did it become a serious concern?

In what general circumstances does the cat misbehave?

Has the problem changed in frequency? (please describe)

Has the problem changed in intensity? (please describe)

Has the problem otherwise changed?

Describe several examples in detail:
Most recent incident: (Date:         )

Second to last incident (Date:       )

Third to last incident (Date:      )

Other significant incidents:

What have you done so far to correct the problem?

How do you discipline your cat for this and for other misbehavior?

Home Environment:
Please list the people living in your household, including the ages of the children:
Name:						Age		Hours away from home
1.	_______________________	_____		_______________________
2.	______________________	_____		_______________________
3.	______________________	_____		_______________________
4.	______________________	_____		_______________________
5.	______________________	_____		_______________________
Please list animals in the household including the patient:
Name		          species     breed	 gender   age obtained  current age
_____________  _____  _______________  ____  __________  _________
_____________  _____  _______________  ____  __________  _________
_____________  _____  _______________  ____  __________  _________
_____________  _____  _______________  ____  __________  _________
_____________  _____  _______________  ____  __________  _________
In what sequence were the animals obtained?  (please number the animals in the table above) What is your cat's relationship to the other animals? (friendly, hostile, fearful) Please describe:

What type of area do you live in? (Check one) City/town ___  Suburbs ___  Rural ___
What type of house do you live in?  Please describe:
Have you moved since acquiring the cat? Y/N How many times?
Has your household (people and animals) changed since acquiring your cat? Y/N 
Please describe:

What is your daily schedule in regards to your cat (Typical 24 hour day):

Does your cat go outdoors?
Is your cat supervised when outdoors? If so please describe (on a leash, on the deck with you, in the yard with you, etc)
Does your cat use a pet door?
Is your cat harness or leash trained?
What percentage of the time does your cat spend outdoors:____% indoors/___%outdoors

Cat's Background:
Why did you decide to get a cat?
Why did you choose this breed?
Where did you get this cat? (check one) shelter ___  Breeder (newpaper or internet) ___ Breeder (referral) ___  Pet store ___  Friend ___  Stray ___  Other: _____________
Have you owned cats before? Y/N
How old was your cat when acquired?
If known, how many littermates: male:  _____ female: ______
How many cats were there to choose from? _____________
Why did you choose this cat over the others? (please be specific): 	

Describe your cat's behavior as a kitten:
Do you have any information about littermates' behavior? (Please describe) :

Has this cat had other owners Y/N,  How many? ________
Why was the cat given up?

How long have you had this cat? ____
At what age was your pet spayed/neutered?  ________
Why was this done?
Were there any behavior changes after neutering? (Please describe)

If your pet is intact has she/he ever been bred? Y/N
If you have an intact female, was she a good mother? Y/N
Are you planning to breed in the future? Y/N
Does your cat mount other cats? Y/N
Animals? Y/N
People? Y/N
If yes, who or what is mounted?

Grooming:
Does your cat groom, lick, or bite himself excessively? Y/N
Does your cat’s skin ripple? Y/N
Is your cat declawed? Y/N, If yes: front only or all four?
What was the immediate aftercare? (shredded paper, Yesterday’s News, etc)
Did your cat use this litter?
Did the paws become infected after surgery?
Does your cat use a scratching post or favorite scratching area? Please describe:

How many scratching posts or perches do you have in the household? Please describe:

Diet and Feeding:
What do you feed your cat?  (brand name) _________________________________
Has your cat’s appetite changed? (increased, decreased) 
How much do you feed your cat? (please be specific, amount and frequency) Where is he/she fed?
Where does your cat drink?
Who feeds the cat?
What is your cat's favorite treat?
Social Behavior:
Where does your cat sleep at night?

Has sleeping behavior changed? (sleeping more or less?)
Where is your cat when you have guests?
How does your cat behave with familiar visitors? 
Adults:
Children:
How does your cat behave with unfamiliar visitors? 
Adults:
Children:
How does your cat behave with the veterinarian?
Where is your cat when alone in the house?
Does your cat behave when you return?
How does your cat respond to other cats through the window or in the yard?

When does your cat meow?

When does your cat hiss or growl?
What toys does the cat have?
How do you play with your cat?
Does your cat know any tricks? Please list:

Does your cat chase or stalk you? Please describe:
Does your cat carry toys/objects or “mother” other animals? 
What is your cat’s activity in general?
Low__, Average__, High__, Excessive__
How would you describe your cat’s personality?

Elimination Behavior:
Does your cat use a litter pan? Y/N
How did you litter train your cat?
Does your cat eliminate in the house but outside the litter pan? Y/N (urine or stool)
Please describe in detail where this tends to occur (include substrate-tile, laundry, rug, etc. as well as what rooms.
How many litter pans do you have?
Where are they located? Please be specific:

What type of pans are they (please indicate the number of each):
___ Commercial litter pan with no top (size:     )
___ Commercial litter pan with removable lip (size:    )
___ Covered box “cave” type front door
___ covered box “Booda” type (cat crawls into hole)
___ automatic cleaning
___ dishpan
___ cardboard box
___ other: (Please describe):
How old is each pan?
Do you use a liner? Y/N What type?
What type of litter is used (Please be specific):

Have you recently changed brands? Y/N What were you using before?
How often is the litter scooped? How often is the litter changed?
How do you clean the boxes? How often is this done?

Does your cat cover the urine/feces in the box?
Medical History:
Is your cat on any medication? Please list all medications:

Has your cat been on medication in the past?  Please describe:

Date of the most recent rabies vaccine _______ 1yr/3yr
How would you describe the reason for your visit (please check one)
1.	I am here only out of curiosity, problem is not serious
2.	I would like to change the problem, but it is not serious
3.	The problem is serious, and I would like to change it, but if it remains unchanged that's okay
4.	The problem is very serious and I would like to change it, but if it remains unchanged, I will keep my cat
5.	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.

If your cat has an elimination problem, please provide a rough sketch of your home’s floor plan. Mark windows and door, favorite resting areas and litter boxes. Place an “X” where the cat eliminates.