Client's Name *

First

Last

Phone

Email *

Cat’s date of birth:

Date of birth

Estimated
Known

Patient's name: *

Breed:

Weight (lb/kg):

Sex *

Male
Male Castrated
Female
Female Spayed

If your cat is castrated or spayed [neutered] at what age was this done? (specify in weeks or months) *

Age in weeks at which your cat was adopted? (specify in weeks or months) *

How many owners has your cat had?

How long have you had this cat? *

Is your cat: *

Indoor only
Outdoor only
Indoor/outdoor

How many litter boxes does your cat have? *

What types of litter do you use? *

How often do you change the litter box completely (specify if monthly or weekly)? *

How often do you scoop the box? (specify if daily or weekly) *

Does your cat leave urine or feces outside the litter box? *

Yes
No
Don't Know

Urine—where specifically?

Feces—where specifically?

Both—where specifically?

Does your cat “spray”?

Yes
No
Don't know

If you answered yes, where specifically?

Do you have any concerns, complaints or problems with urination in the house now?

Yes
No

Where is the cat urinating that you find undesirable (list all areas)?

How many times per week is the cat urinating in places you find undesirable?

At what time of day is the urination occurring?

Is the pattern different on days when you are home and days you are not home?

Are you at work during the hours when the cat urinates?

How many times per day does your cat usually urinate when he or she is not urinating in places you find undesirable?

Do you have any concerns, complaints or problems with defecation in the house now?

Yes
No

Where is the cat defecating that you find undesirable (list all areas)?

How many times per week is the cat defecating in places you find undesirable?

At what time of day is the defecation occurring? *

Is the pattern different on days when you are home and days you are not home?

Are you at work during the hours when the cat defecates? *

How many times per day does your cat usually defecate when he or she is not defecating in places you find undesirable?

Does your cat destroy any objects or anything else by chewing, sucking or eliminating on them (e.g., furniture, rugs, clothes)?

Yes
No

If you answered yes, what objects—specifically—does the cat destroy? Please list all of them and note which are destroyed when you are home or not home.

When does the cat destroy objects? *

When home
When gone
Both

Does your cat mouth, bite, suck or nip anything or anyone? *

Yes
No

If you answered yes, to whom is this behavior directed?

Is this a problem for you? *

Yes
No

Does your cat exhibit any vocalization about which you are concerned? *

Yes
No

If you answered yes, what is/are the vocalization(s) and when do they occur?

Vocalization: Situation in which it occurs *

Yowling
Growling
Meowing
Hissing

Does your cat show any signs of hissing, growling or biting? *

Yes
No

If you answered yes, what does the cat do and when does he or she do it?

Sign: Situation in which it occurs *

Yowling
Hissing
Growling
Biting

Have you ever been concerned that your cat is “aggressive” to people? *

Yes
No

If you answered yes, why?

Have you ever been concerned that your cat is “aggressive” to cats?

Yes
No

If you answered yes, why?

Have you ever been concerned that your cat is “aggressive” to animals other than cats?

Yes
No

If you answered yes, why?

Does your cat hunt or prey on other animals?

Yes
No

If you answered yes, which animals and where?

Has your cat ever bitten or clawed anyone, regardless of the circumstances?

Yes
No

If yes, what happened?

Has your cat had any changes in sleeping habits?

Yes
No

If you answered yes, what are these changes?

Has your cat had any changes in eating habits?

Yes
No

If you answered yes, what changes have occurred?

Has your cat had any changes in locomotory behaviors or the ability to get around or jump on the bed, etc.?

Yes
No

If you answered yes, what changes have occurred?

Has anyone ever told you that they were afraid of your cat? *

Yes
No

If you answered yes, what did they say?

Has anyone every told you that your cat was ill-mannered?

Yes
No

If you answered yes, why—what did the cat do that made them say this?

Do you have any concerns about your cat’s grooming behaviors? *

Yes
No

If you answered yes (please select all that apply):

Is the cat exhibiting any behaviors about which you are concerned, worried or would like more information? *

Yes
No

If you answered yes, please list these behaviors below:

Feline Behavior Questionnaire Form

Feline Behavior Questionnaire Form

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