Name *

First

Last

Pet's Name *

Email *

Phone *

Chief Complaint: In one or two sentences describe the primary reason you’re bringing your pet for a behavior consult. *

When did you FIRST notice it? *

When did you first realize it was a problem? *

Describe a typical episode or event. *

Has the problem gotten worse? If so, over what time period? *

Goals: What is your ultimate goal? What will you be satisfied with? What will you do if you cannot reach these goals? (Find a new home? Return to breeder? Euthanize?) *

How long have you had your pet and when and where did your acquire him/her? *

If you acquired him/her from and animal shelter or rescue organization do you know why she was surrendered to the organization? *

Why did you get your pet? *

Is your pet neutered/spayed? *

Yes
No

If so, at what age and what was your reason for neutering/spaying? *

If not neutered/spayed, do you plan on showing or competing with your pet and then breeding? *

Has your pet ever been bred? *

What type and brand of food does your pet regularly eat? *

How often and how much do you feed and how much of it does he/she eat? *

Does he/she eat it all right away? *

Yes
No

Where is he/she fed and by whom? *

Does he/she get table scraps, treats or supplements more than 2x a week? If so, how often and what? *

When was your pet’s last veterinary health check? *

Are vaccines current? If so, when were they given? *

Is your pet on heartworm medication? Which one? *

Is your pet on flea preventive medication? Which one? *

Does your pet have any known medical problems or past surgeries? *

Yes
No

Is he currently being treated for medical problems? *

Yes
No

Has your veterinary performed a medical work-up for the behavioral problem? (please describe) *

Please list all animals in the household *

(Name, breed, sex, age obtained, current age, any problems)

Please list the people, including yourself, currently living in the household *

(Name, sex, age range, relationship, occupation)

Describe any exercise. *

Where does your cat stay during the day when you’re home? *

Where does he/she stay at night? (where do they sleep) *

Where does he/she stay when guests visit? *

What percentage of time does he/she spend indoors vs outdoors? *

Does he/she roam the neighborhood freely? *

Yes
No

Has your cat had formal training or socialization classes? If so, when, where, who took him/her, and how did he/she do? *

What will he/she do on command at home? What will he do when distracted, such as when visitors come over or when there’s some outside distraction? *

Anything else we should know about his/her training and socialization? *

Signature *

Please note: We will be closed on Monday, May 29th, in observance of Memorial Day!

Feline Behavior History Form

Feline Behavior History Form

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