Cat Initial Behavior Consultation History

Welcome to our Initial Cat Behavior History Form. We look forward to working with you and your cat.

Before You Begin

This is a detailed form and typically takes 15–20 minutes to complete. For the best experience, please complete it on a desktop or laptop computer rather than a mobile phone or tablet.

The form must be completed and submitted in a single session. Your progress may not be saved if you close the page, refresh your browser, or leave the form before submitting it. We recommend setting aside enough uninterrupted time to complete the entire form.

The information you provide is important to our team and helps us prepare for your cat’s appointment. Please answer each question as thoroughly and accurately as possible.

When you have completed the form, click Submit at the bottom of the page. You will be directed to a confirmation page, and a copy of your responses will be sent to the email address you provide.

If you do not see the confirmation page or receive a confirmation email, please check your spam or junk folder. If you still have not received confirmation, or if you have not heard from our team within 72 hours, contact us at behavior@hickoryvet.com.

"*" indicates required fields

Patient Information

Name*

Breed*

Cat's Date of Birth (if unknown please give approximate date)*

Gender*

Female Spayed

Male Neutered

Female Intact

Male Intact

Coat Color*

Owner Information

Is this dog/cat currently owned by a rescue or shelter organization?*

Yes

Owner Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone Number*

Emergency Phone Number*

Email*

Rescue Name*

Rescue Mailing Address*

Street Address Address Line 2 City State ZIP Code

Rescue Phone*

Phone number for the individual who can make medical and financial decisions for the pet

Rescue Email*

Email address for the individual who can make medical and financial decisions for the pet

Foster Name (if applicable)

First Last

Foster Phone (if applicable)

Foster Email (if applicable)

In order to best treat rescue pets we prefer if someone who knows the pet well, and has spent a lot of time with them, attends the appointment. This helps us get the most efficient history possible and best help your adoptable pet.

Co-Owner Information

Co-Owner Name

First Last

Co-Owner Phone Number

Co-Owner Email

Veterinarian

Primary Veterinarian*

Primary Veterinarian Phone*

Primary Veterinarian Email*

How did you hear about us?*

Household Information

List the people that live in your household:

Name

Age

Relationship (spouse, child, etc.)

List any other pets in the household (e.g., Anna, 11yo, dog spayed, female):

Name

Age

Species

Sex

Home & Neighborhood

Type of House*

How long have you lived in this house?*

Since adoption, how many houses have you and your cat lived in?*

Neighborhood Style*

Urban

Suburban

Rural

List any major household changes since acquiring this cat (ie moves, illness/death of pets/people, added new people/pets to household etc.):

Acquisition Information

How long have you owned this cat?*

How old was the cat when acquired?*

Where did you obtain this cat?*

Behaviors of cat's parents / litter mates (if known)*

Describe previous homes (if known)*

If obtained from a shelter/rescue, describe the information you were given prior to adoption:*

Why did you choose this breed of cat?*

Why did you choose this individual cat?*

Why did you acquire this cat (check all that apply)*

Adult's pet

Family pet

Children's pet

Companion to other pet

Show

Breeding

Other

Spay & Neutering Information

Is this cat neutered / spayed?*

Yes

If yes, at what age?

Reason for spay/neuter?

Prevent behavior problem

Health/vet recommended

Population control/don't want to breed

Adoption agreement

Correct behavior problem

Other

If spayed/neutered due to behavior problem, list the problems present before surgery you hoped to correct:

Did you notice any changes after neutering/spaying?

Yes

If yes, please describe:

Medical History

List major illnesses, surgeries and any chronic illness (include dates):*

Please list all medications/treatments your cat is CURRENTLY receiving:

How many medications is your cat currently receiving?*

If your cat is receiving medication(s), list medication name, dose, frequency, and start date:

Daily Activities / Routine

When and where is your cat fed?*

Do you use a slow feeder or food dispensing device?*

Yes

If yes, please describe the feeder/device:

Does your cat have food available all day?*

Yes

Dry (Brand)*

% of Diet (Dry)*

Canned (Brand)*

% of Diet (Canned)*

Raw (Brand/Type)

% of Diet (Raw)

Other (Describe)

% of Diet (Other)

If you feed a special diet (hypoallergenic, grain free etc.) why?

Eating Habits (check all that apply)*

Eats right away

Picky eater

Anxious eater

Other

List types of treats*

How often does your cat get treats?*

When does your cat get treats?*

Where does your cat sleep at night?*

Where does your cat sleep during the day?*

Does your cat go outside?*

Yes

If yes, does your cat have

Free access to outside (e.g., via pet door)

Controlled access

Please describe outside access (times/limits, leash, fenced yard, etc.):

Does your cat play with toys?*

Yes

If yes, what are your cat's favorite toys?

How often does your cat play with toys?

How often does your cat play with people?

How often does your cat play with other animals?

How many litter box(es) do you have?

Describe your cat's litter box(es): location, box type/size, litter type, additives, cleaning products*

How frequently are litter boxes scooped?*

How frequently are litter boxes cleaned?*

What cleaning products do you use?*

If there will be or have been any major changes to the daily routine, please describe:*

Weekly Problem Behaviors (Frequency Context)

Does your cat engage in housesoiling at least once weekly?

Does your cat engage in excessive vocalizations at least once weekly?

Does your cat engage in destructive scratching at least once weekly?

Self licking/chewing at least once weekly?

Pacing/repetitive behavior at least once weekly?

Consuming non-food objects at least once weekly?

Circles/chasing tail/freezing at least once weekly?

Reactions to People / Animals / Stimuli

How does your cat react to unfamiliar people at the door?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

How does your cat react to unfamiliar people in the home?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

How does your cat react to babies?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

How does your cat react to children?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

How does your cat react to other cats that live in the household?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

How does your cat react to other cats (does not live with)?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

How does your cat react to dogs in the household?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

How does your cat react to other dogs (does not live with)?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

How does your cat react to squirrels/birds/etc.?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

How does your cat react to carriers?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

How does your cat react to car rides?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

How does your cat react to the veterinarian's office?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

How does your cat react to being left alone?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

How does your cat react to thunder?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

How does your cat react to loud noises?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

How does your cat react to petting by familiar people?*

Happy

Neutral

Fearful

Anxious

Runs/hides

Hiss/growl

Scratch

Bite

Don't know/don't do

Primary Behavior Problem

What is the one main behavior problem you wish to address?*

Describe the very first incident of this problem. Try to remember the earliest occurrence of the problem, even if it wasn't as serious as it is now. If you noticed any changes in your cat's body language or facial expression before, during or after the incidents please describe. For example, if your cat is aggressive to people, describe the first time she hissed or growled at someone, not the first bite. Or if your cat has been house soiling, describe the first "accident" you found. If you noticed any changes in your cat's body language or facial expression before, during or after the incidents please describe.*

Date of the first incident (approx OK)*

Describe the MOST RECENT incident (per instructions):*

Approx date of the most recent incident*

Describe, per instructions above, at least one other incident you feel illustrates the problem behavior (if you would like to describe other incidents, that's great!):*

Date of additional incidents:*

How frequently does this behavior occur?*

Is the frequency...*

What percent of the time in a potentially problematic situation does the problem behavior occur?*

What have you tried to do to correct this behavior problem and how did your cat respond?*

How serious do you and other members of the household find this problem?*

Has anyone suggested that you euthanize or rehome this cat because of this problem?*

Euthanize

Rehome

Neither

Have you ever considered euthanasia or rehoming your cat because of this problem?*

Euthanize

Rehome

Neither

List other problem behaviors in order of importance to you:*

Media Permission

Do we have permission to post pictures on our social media?*

Yes

Please upload your favorite picture of your pet!

Accepted file types: jpg, jpeg, png, webp, Max. file size: 7 MB.

Signature*