hosted by tripod
E-mail this page to a friend Tell me when this page is updated
Cat Behavior Counseling Questionnaire

While we are underconstruction please print out questionnaire,
complete and forward to Animal Behavior Services via Fax or Mail.
Add additional pages if necessary.

Fax:
410-744-9962

Mail:
Joanne Oliva-Purdy, Ph.D.
Animal Behavior Services
1402 Lincoln Woods Drive
Catonsville, MD 21228
 
Section 1: Owner's Information
Date: / / (mm/dd/yy)
Name:
Address:
City:
State: Zip:
Phone: Day Evening
Best time of day to be reached:
E-mail:

 

Section 2: Cat's Information
Name:
Breed/Type: Long Hair    Short Hair
  Purebred   Mixed Breed
Sex: Male   Female
Neutered: Yes   No
Present Age: years months
Age when acquired: years months weeks
How long you have owned your cat: years months
Acquired from
what source:		 pet shop  shelter  breeder 
Other:
Weight:

 

Section 3: Veterinarian
Do you have a "usual vet": No  Yes, complete below
Name:
Address:
City: State: Zip:
Phone:
E-mail:
Last visit to a vet:
Current Medical Problems:

Past Medical Problems:

 

Section 4: Family
List all people living in home:
Name
Gender
Adult/Child (Age)
Relationship
Occupation

 M
 F

 Adult
 Child's Age 

 M
 F

  Adult
 Child's Age 

 M
 F

  Adult
 Child's Age 
 M
 F		  Adult
 Child's Age 
Other animals living with the family:
Species/Breed
Gender
Age acquired
Current age
Interaction with subject Cat
M
 F
M
F
M
F
Changes in household since pet acquired (including moves)
Section 5: Cat's Environment and Routine
Area: urban  suburban  rural
Home: Apartment  Attached House 
Single Family House  Other
Where is the cat kept?

outside
inside,
    Are Rooms off Limits?  No  Yes,
        Which rooms:
Where does it sleep?
Where is it fed?
Who feeds it?
Where is(are)
litter box(es)?
Litter used:
Favorite spots to rest?
What tends to go on where and when it spends it's time?

Who spends the most time with the cat?
What is available for the cat to play with?
Describe typical day:

Rules
Can't do.....

Allowed to do when "asks".....

Allowed complete freedom to...

 

Section 6: Cat's Diet
Veterinary Prescriptions:
How are medications given:
Soft Food:
When is cat fed?
How much?
How much is usually eaten?
Hard Food:
When is cat fed?
When is hard food available?
How much is usually eaten?
Other parts of regular diet:
Treats: hand-fed items or items not regular part of diet
Favorite Treat:
(gets exited over and/or quickly takes)


How cat gets treats? in dish  placed somewhere else  hand-fed
Any further details:

 

Section 7: Cat's Behaviors
The Problem(s): Mark all those that apply
Most Serious
Somewhat
serious
Less serious
Problem
Biting or other aggression towards:
people or  other cats  both
Elimination other than in litter box or outside the home
Excessive fear, including fear of separation
Undesirable distructive behavior
(tearing /scratching / chewing without ingesting)
Non-food eating problems (including plants)
Food eating problems/begging
Sucking / non-aggressive mouthing / play attacks
Overgrooming
Going into or onto off-limit area (such as jumping on counter or bolting out the door)

Other:

 

Other:
Other typical
non-problem behaviors:

How does it react to
vet visits

whoever does grooming

cat carrier / trips

familiar people

strangers

Changes in household since pet acquired (including moves)

 

Section 8.1: Cat's Most Serious Problem
Describe problem in detail, include chronological list of recent events and changes in behavior:
Problem:
History:
Did the cat have the problem when acquired? Yes   No
Did the cat develop the problem afterwards? Yes   No
When was the problem apparent?
How old was the cat?
How often does it occur? daily    weekly    monthly
Usual circumstances when the problem occurs:

But the problem sometimes happens when...
What we have tried so far to correct it and what results that has had:
Additional information:

 

Section 8.2: Pet's Next Most Serious Problem
Describe problem in detail, include chronological list of recent events and changes in behavior:
Problem:
History:
Did the cat have the problem when acquired? Yes   No
Did the cat develop the problem afterwards? Yes   No
When was the problem apparent?
How old was the cat?
How often does it occur? daily    weekly    monthly
Usual circumstances when the problem occurs:

But the problem sometimes happens when...

What we have tried so far to correct it and what results that has had:
Additional information: