Feline Initial Behavior Consultation History Please complete the form below prior to your appointment. If you have any questions please email us at info@metro-vet.com. "*" indicates required fields General InformationName* First Last Date of Appointment* MM slash DD slash YYYY Who referred you?*Basic Pet InformationCat's Name*Current Age (indicate months or years)*Breed*Sex*MaleFemaleSpay or Neutered?* Yes No Date When Acquired* MM slash DD slash YYYY Source Breeder Shelter/Rescue Stray Other Did you meet your cat's parents?* Neither Mother only Father only Both Mother and Father History Prior to Acquisition (if known)Household InformationHousehold Members (including you)*NameAgeRelationship to youOccupationRelationship with pet (e.g., follows, trains, no interaction, etc.) Add RemoveIs anyone in the household pregnant or planning to adopt or foster a child in the near future? (This is asked for safety reasons. You are not obligated to answer.) Yes No Please provide a due date if applicable or any relevant informationHave you had cats as an adult before? Yes No Household Pets (aside from cat presenting for evaluation)NameSpeciesAge, breed, sex, neuter statusInteractions with patient Add RemoveWhat type of home do you reside in?*Apartment/CondoTownhouseSingle family houseOtherOther home type*How many rooms are in your home?*Have there been any changes in your household since acquiring your cat (e.g. new job, move)?* Yes No Explain:*Aggression (if applicable)Only fill out information about triggers that apply to your cat; otherwise leave the field blank.For any trigger applicable to your cat, please describe specific incidents of aggression including:your pet’s age when it was first observed and at the time of incident(s)targets of the aggressionlocationhow you respondedfrequency of incidentsbody language (growling, hissing, lunging, biting)any other relevant informationPeople living in the homeOther pets in the homeGuestsUnfamiliar cats seen outside the homeVeterinary clinicOther triggers of aggression not listed aboveBite History (if applicable)Has your cat made contact with an individual during the aggression? Yes No What type of injury? Scratch Bruise Puncture(s) Tear How many times has your cat bitten a person?How many times has your cat bitten a cat/other animal?How many times did a bite break skin with a person?How many times did a bite break skin with an animal?If your cat has a bite history, was any incident reported to Animal Control or other authorities? Yes No To whom?Is there any legal action pending because of this pet? Yes No Which incident(s)?*If not already described, please explain the bite incidents.Anxiety ScreenWhat is your cat’s response to changes in the environment or subtle, sudden noises?*Does your cat have any difficulty settling within the home?*Does your cat do any of the following more than you would expect? Lip licks or yawn Lick or chew their body Lick objects Lick people Does your cat display any reaction to noises such as thunderstorms, fireworks, or other loud noises?* Yes No Explain:*Does your cat do any of the following? Chase his/her tail Chase lights/shadows Exhibit skin twitching Snap at the air Other fears or anxieties not already describe:Describe your cat’s behavior at the veterinary clinic, if not already described:Elimination Behavior (only fill out if your cat is eliminating outside of the litter box)Please provide the following details for each litterbox in your home:LocationBox type & sizeLitter typeWhether a liner is present Add RemoveHave there been any recent changes to the litter boxes? Yes No Please describe them:How often is waste scooped out?How often is the litter replaced?How often is the box completely emptied out and washed?What do you use to clean/wash the litter box itself?Does your cat prefer to use a freshly cleaned litter box? Yes No Will your cat eliminate in the presence of people or other animals? Yes No Does your cat bury his/her eliminations? Yes No Does your cat scratch and dig in and around the box? Yes No Does your cat ever run out of the box after eliminating? Yes No Problem elimination behaviorWhat is your cat leaving outside the litter box? Urine Feces Both Frequency:How long has this behavior been occurring?What time of day do you usually find the deposits outside the box?When the problem first began, do you recall any unusual incident at the time or something that may have upset the cat (in the environment or medically)? Yes No Please explain:Have you ever witnessed your cat eliminating outside the litter box? Yes No What is your response when your cat eliminates outside of the litter box?If your cat is urinating outside the litter box, where does it occur? Vertical surfaces (e.g., walls, curtains) Horizontal surfaces (e.g., floor, carpets) How do you clean eliminations outside of the litter box?Has your cat had urinary tract infections or other urinary issues? Yes No Please explain:When was the last time a urine sample was examined by your veterinarian?What has been done in the past (medical, environmental, behavioral) to change this behavior?Has anything been effective in decreasing or eliminating the problem? Yes No Please explain:Scratching BehaviorIs your cat declawed? No Front only All four feet At what age?Do you have scratching posts? Yes No What type (orientation, material) and where are they located?Does your cat use the scratching posts? Yes No Does your cat scratch in undesirable locations? Yes No Where and what have you tried to stop it?Other Behavior ConcernsDescribe any other behaviors you find concerning that you have not yet mentioned.Daily ActivitiesWhere does your cat spend the most time in the home?Is your cat ever confined?* Yes No During what situations?*With which method (e.g., crate, baby gate, behind a door)?*What is their response?*How often do you play with your cat?* Never 1-2 times per day Multiple times per day Other Other amount:*Is your cat playful?* Yes No Explain:*What kinds of toys does he/she like?*How does your cat respond to catnip?Have you performed any training with your cat?* Yes No What training?*How do you correct your cat when he/she misbehaves?*What types of training aides do you currently use?*What types of training aides have you previously used?*Is your cat allowed to go outside?* Yes No Where do they spend time, for how long, and is access controlled by you?*Medical HistoryPrimary Care Veterinarian Clinic*Veterinarian's Name*Date of Last Veterinary Visit MM slash DD slash YYYY Estimated Weight (indicate pounds or kilograms)*Has your cat had baseline blood work (CBC, chemistry) performed within the past year?* Yes No Date of last blood work* MM slash DD slash YYYY Please list your pet’s current medications, supplements, or other treatments belowName of heartworm preventativeName of flea/tick preventativeMedicationsNameDose (in mg)Frequency (e.g., once daily, as needed) Add RemoveHas your cat previously been prescribed medications, supplements, or pheromones for his/her behavior that are not listed above?* Yes No Please list the name, date started, date discontinued, dose, and effects.*Any chronic medical conditions?* Yes No Explain:*Any current or history of pain (limping, difficulty getting up or lying down, resistance using stairs, slowing down on walks)?* Yes No Explain:*Have you noticed your pet exhibiting any of the following in the last 3 months? Itching Vomiting Diarrhea Other What else?*Does your pet have a history of seizures?* Yes No Current Diet Brand*Amount and Frequency*How would you describe your cat's appetite?* Excessive Good/Average Poor Explain:Does your cat have any confirmed or suspected food allergies or sensitivities?* Yes No Note: We will offer treats during the appointment based on this answer.Explain:Future ConsiderationsWhat are your goals for treatment?*Have you considered rehoming or behavioral euthanasia for your cat?*Please tell us about your favorite qualities and interactions that you have with your cat!*Layout of the homeIf you think it will be helpful, please describe the layout of your home or draw a map and bring it to your appointment. Indicate the location of the following areas: food, water, litter boxes, rest areas, cat trees, scratching posts, windows, and doors. You can email this to us ahead of time or bring it to the appointment.
