Vet-to-Vet Feline Behavior Consultation Form "*" indicates required fields InstagramThis field is for validation purposes and should be left unchanged.General Information & Medical HistoryClinic name*Veterinarian’s name*Referring veterinarian role* Patient’s primary care vet Specialist Other If specialist, please note specialty*If other, please describe*How did you hear about us?Date of pet’s last veterinary visit MM slash DD slash YYYY Has the cat had baseline blood work (CBC, chemistry) performed within the past year?* Yes No Date of last blood work* MM slash DD slash YYYY Any abnormal results*Current medications, supplements, or other treatmentsName & FormulationDose (in mg)Frequency (e.g. every 24 hours, as needed) Add RemoveHas the cat previously been prescribed medications, supplements, or pheromones for behavior that are not listed above?* Yes No 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.Any chronic medical conditions?* Yes No If yes, please explain chronic medical conditions*Any current or history of pain (limping, spending more time on low surfaces, hesitating to jump, etc.)?* Yes No If yes, please explain pain history*Any appetite concerns?* No Excessive Good/Average Poor If not "No", please explain appetite concerns*Basic Pet InformationCat’s name*Signalment*Include species, breed, sex, reproductive status, and age.Weight (indicate pounds or kilograms)*Relevant history prior to acquisition, if knownDoes 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 ProblemsDescribe 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 OccupantsHousehold occupantsNameRelevant information about care/relationship Add RemoveHousehold Pets (aside from cat presenting for evaluation)Household pets (aside from cat presenting for evaluation)NameSpecies Add RemoveElimination Behavior (only complete if the cat is eliminating outside of the litter box)How many litter boxes are in the home?Litter box details Add RemoveFor each litter box, provide: Location, Type, Size, and Litter type.Have there been any recent changes to the litter boxes? Yes No 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?Does the cat prefer to use a freshly cleaned litter box? Yes No Will the cat eliminate in the presence of people or other animals? Yes No Does the cat bury his/her eliminations? Yes No Does the cat scratch and dig in and around the box? Yes No Does the cat ever run out of the box after eliminating? Yes No Problem Elimination BehaviorWhat is the cat leaving outside the litter box? Urine Feces Frequency of eliminations outside the litter boxInclude approximate times per day/week/month.How long has this behavior been occurring?When the problem first began, was there any unusual incident or something that may have upset the cat (in the environment or medically)? Yes No If yes, please explain the unusual incident or change*Has the client witnessed the cat eliminating outside the litter box? Yes No What is the client’s response when the cat eliminates outside of the litter box?If the cat is urinating outside the litter box, where does it occur? Vertical surfaces (e.g., walls, curtains) Horizontal surfaces (e.g., floor, carpets) How does the client clean eliminations outside of the litter box?Has the cat had urinary tract infections or other urinary issues? Yes No 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?Has anything been effective in decreasing or eliminating the problem? Yes No If yes, please explain what has been effective*Training and ObedienceHas the client done any training with their cat? On their own Private in-home Virtual No Trainer informationInclude 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.)? CurrentlyWhat types of training aides have the clients used with this cat? PreviouslyDaily ActivitiesWhat 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 ConsiderationsWhat are the client’s goals for treatment?*Are they considering rehoming or behavioral euthanasia for their cat?* Yes No Unsure If yes or unsure, please provide details*Please leave any comments about the form or information that did not fit in any other section.
