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Feline Behavior Questionnaire

Client and Pet Information
Please list the problem behavior(s). Please note the relevant degree of concern:
Degree of concern:
Degree of concern:
Degree of concern:
Please note if this behavior occurs
Duration of problem
Your Cat's Beginning
Your Cat's Home Life
Please list the people, including yourself, currently living in the household now:
Please list all the animals (including all pets, even non-cats)in the household.
Toiletry Habits
Primary Behavioral Screen
Please note which behavior, list all that apply:
Stereotypic and ritualistic behavior
Grooming:
Pertaining to the above-listed behaviors:
In-depth screen
We want to know what your cat does when you routinely interact with her/him. If you don't know how your cat would react in the following circumstances, please do not try to find out because you may provoke your cat. Please note if the person is a family member, familiar person, or stranger. Please note a dog or cat as a family member, familiar "friend" or stranger.
Key  
  • NR - No reaction    
  • S - Star    
  • B - Bite    
  • H - Hiss, how, growl, vocalize    
  • SW - Swat/ Scratch  
  • P - Piloerect/arch/puff up    
  • TS - Switch or twitch tail  
  • WD - Withdraw 
  • NA - Not applicable
Your cat will do this when:
Previous Therapy History
This questionnaire is designed to help us evaluate any role previous treatment may play in either your cat's problems or in their resolution. Please complete to the best of your ability and if our lists are not complete, or you feel that an explanation is warranted, please complete the "comment" section at the bottom.
If you answer yes to any of these questions, please indicate who recommended the treatment and if you attempted it, and indicate the outcome.
Thank you for taking the time to carefully complete this form.
Information and knowledge are powerful. Gaining this information is the first step in helping your cat to be healthy and happy.  
We look forward to reviewing and discussing your answers with you soon.
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