Vet-to-Vet Feline Behavior Consultation Form - Metropolitan Veterinary Associates

Phone

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General Information & Medical History

Clinic name*

Veterinarian’s name*

If specialist, please note specialty*

If other, please describe*

How did you hear about us?

Date of pet’s last veterinary visit

Any abnormal results*

If yes, please list the name, date started, date discontinued, dose, and effects*

Include name, date started, date discontinued, dose, effects, and reason for discontinuation if applicable.

If yes, please explain chronic medical conditions*

If yes, please explain pain history*

If not "No", please explain appetite concerns*

Basic Pet Information

Cat’s name*

Signalment*

Include species, breed, sex, reproductive status, and age.

Weight (indicate pounds or kilograms)*

Relevant history prior to acquisition, if known

Does the cat have signs of generalized anxiety disorder?

For example: easily startles with changes in the environment or subtle noises; difficulty settling within the home.

Current Behavior Problems

Describe the main behavioral concerns for the cat that prompted the consultation.*

Provide details surrounding the problem (e.g., location, people or animals involved, frequency, etc.).*

How old was the cat when it started?

Household Occupants

Household Pets (aside from cat presenting for evaluation)

Elimination Behavior (only complete if the cat is eliminating outside of the litter box)

How many litter boxes are in the home?

If yes, please describe the changes to the litter boxes*

How often is waste scooped out?

How often is the litter replaced?

How often is the box completely emptied out and washed?

What does the client use to clean/wash the litter box itself?

Problem Elimination Behavior

Frequency of eliminations outside the litter box

Include approximate times per day/week/month.

How long has this behavior been occurring?

If yes, please explain the unusual incident or change*

What is the client’s response when the cat eliminates outside of the litter box?

How does the client clean eliminations outside of the litter box?

If yes, please explain urinary tract infections or other urinary issues*

When was the last time a urine sample was examined?

What has been done in the past (medical, environmental, behavioral) to change this behavior?

If yes, please explain what has been effective*

Training and Obedience

Trainer information

Include trainer name, organization, and contact information if applicable.

What types of training aides have the clients used with this cat (e.g. squirt bottles, clicker training, etc.)? Currently

What types of training aides have the clients used with this cat? Previously

Daily Activities

What daily exercise and enrichment does the cat receive?

Does the cat ever chase his/her tail, go after lights/shadows, show skin twitching, or snap at the air when nothing is present?

Future Considerations

What are the client’s goals for treatment?*

If yes or unsure, please provide details*

Please leave any comments about the form or information that did not fit in any other section.