FELINE BEHAVIOR CONSULTATION QUESTIONNAIRE GENERAL INFORMATION Name: Date of consultation: Address: Postal (zip) code: Email: Home

Phone: Business Phone: Fax: Veterinarian clinic: !linic phone: !linic address: "eferred #$ (if other than %eterinarian): PET INFORMATION Pet&s name: Breed: !olor: Date of #irth: 'ei(ht: )ex: * F Neutered+ , N A(e neutered: Decla-ed+ , N . A(e at decla-in(: An$ chan(e after neuterin(+ An$ chan(e after decla-in(+ A(e o#tained: 'here did $ou o#tain this pet+ Breeder/ if applica#le: Beha%ior of parents or littermates: ENVIRONMENT/LIFESTYLE 'h$ did $ou o#tain $our cat+ (companion/ #reedin(/ etc0) 1$pe of food: 'hen is pet fed+ Descri#e eatin( ha#its (e0(0/ pic2$/ %oracious): 3ist treats or supplements: Ho- often are the$ (i%en+ Fa%orite treat:

Do $ou (i%e catnip+ , N Ho- often+ !at&s reaction: Does $our cat hunt+ , N 'hat does $our cat hunt+ 'hat does cat do -ith pre$ after cau(ht+ Explorator$ and self4pla$0 Fa%ored self4pla$ to$s: Fa%ored self4pla$ (ames: Fa%ored pla$ times: Does the cat ha%e a pla$ center+ , N Descri#e: 5nteracti%e pla$0 3ist (ames acti%ities cat en6o$s: 'ho pla$s -ith cat+ Ho- often+ Fa%ored pla$ times:

Ho- lon( is the cat home alone on the a%era(e da$+ !at&s reaction to #ein( alone: 5s cat e%er allo-ed outdoors+ , N 5s cat e%er outdoors unsuper%ised+ , N Ho- often and for ho- lon(+ Descri#e -here cat sta$s sleeps at each of the follo-in( times: Da$time (-hen o-ners at home): Da$time (-hen o-ners a-a$): Ni(ht4time: 'hen (uests %isit: Ho- does $our cat react to the follo-in(: !ar rides: 7nusual loud noises: )tran(ers in home: Ne- (non4famil$) cats: Ne- do(s: REINFORCER ASSESSMENT 5f $our cat -as allo-ed to ha%e an$ treat/ -hat -ould it prefer0 3ist top fi%e: 'hat other t$pes of re-ards -ould entice $our cat (pla$ to$s/ catnip/ attention affection)0 3ist top fi%e:

FAMILY/RELATIONSHIPS 3ist each famil$ mem#er (include sex and a(e): Ho- does $our cat (et alon( -ith each famil$ mem#er+ 'ho feeds+ 'ho (rooms+ 'ho (i%es treats+ 'ho pla$s+ 'ho trains+ Briefl$ descri#e the famil$ schedule/ includin( ho- lon( the cat is left alone: 3ist an$ other pets/ includin( species/ #reed/ a(e/ and sex: Ho- do the pets (et alon( -ith each other+ TRAINING 'hat commands does $our cat respond to+ Descri#e $our cat&s learnin( a#ilit$: 'ho does $our cat respond to the #est+ 3ist an$ 8tric2s& $our cat can perform: Ha%e $ou used a #od$ harness on $our cat+ , N !at&s reaction: HANDLING Ho- does the cat react to the follo-in(: "estrainin( on $our lap: Nail trimmin(: 9roomin( #rushin(: 9i%in( pills: 9i%in( li:uid medication: !leanin( treatin( ears: 3iftin( carr$in(: Pattin( stro2in(: Bathin(: PERSONALITY Briefl$ descri#e $our cat&s personalit$ (friendl$/ #old/ acti%e/ pla$ful/ aloof/ independent/ fearful/ etc0):

PUNISHMENT Ho- does $our cat react to each of the follo-in( t$pes of punishment: Ph$sical: Noise (siren): 7ltrasonic (Pet4A(ree1*): 'ater spra$er: Ver#al: 'hat punishment is most effecti%e+ Descri#e an$ punishment that has had an ad%erse effect: Does the cat respond differentl$ to different famil$ mem#ers+

GROOMING, SCRATCHING, AND KNEADING Does $our cat (room itself+ , N 5f $es/ does the (roomin( appear to #e (circle one) normal excess less than expected+ 'hen is $our cat most li2el$ to (room+ Does $our cat lic2 or (room (circle all that appl$) other cats in the home people in the home o#6ects+

Are there situations times of $ear that cause (roomin( to increase+ , N 5f $es/ descri#e: Does $our cat ha%e a scratchin( post+ , N 5f $es/ descri#e: Does $our cat scratch an$ areas o#6ects other than its scratchin( post or pla$ areas+ , N 5f $es/ descri#e: 'hen is $our cat most li2el$ to scratch+ Are there an$ situations times of $ear that cause scratchin( to increase+ , N 5f $es/ descri#e: Does $our cat 2nead+ , N 5f $es/ descri#e: 'hen is $our cat most li2el$ to 2nead+ Are there situations times of $ear that cause 2neadin( to increase+ , N 5f $es/ descri#e: Do $ou feel $our cat&s scratchin(/ 2neadin(/ or (roomin( is unusual or excessi%e+ , N 5f $es/ descri#e:

ELIMINATION AND LITTER INFORMATION Does $our cat use a litter#ox for stools+ , N sometimes For urine+ , N sometimes Does $our cat also eliminate outdoors+ , N 5f $es/ -hat percent of defecation is outdoors+ ;;;; < 'hat percent of urination is outdoors+ ;;;; < Does $our cat di( #ur$ after eliminatin(+ , N Does $our cat housesoil+ , N 5f $es/ circle all that appl$: urine horizontal surfaces urine %ertical surfaces stools 'here is $our cat&s preferred elimination location+ Ho- often is the litter#ox cleaned chan(ed+ 3itter#ox location 1$pe of litter 1$pe of #ox =0 >0 ?0 5ndicate -hich of the a#o%e #oxes $our cat prefers: 5f $ou ha%e more than one cat/ do the$ ha%e different litter#oxes+ , N Do the cats use each other&s litter #oxes+ , N 5f no/ descri#e -here each cat&s #ox is located: YOUR CATS HOME ENVIRONMENT Descri#e $our home: House/ apartment/ semidetached home/ #asement/ trailer home/ etc0 Ho- man$ stories+ Ho- man$ rooms+

Please dra- a simple dia(ram of each floor of $our home to sho- all places $our cat eliminates:

7se the follo-in( 2e$s to indicate the location of each of the follo-in(: @itt$ litter: (use num#ers =/ >/ ? to correspond to #ox locations a#o%e) Feedin( location: F Pla$ area: P )cratchin( post: )P )ite of inappropriate scratchin(: D )leepin( area (ni(ht4time): )N )leepin( spots (da$time): )D )ite of inappropriate elimination urine: 7 )ite of inappropriate elimination #o-el mo%ements: B*

FELINE ELIMINATION PROBLEM QUESTIONNAIRE (please proceed to next section if $our cat does not ha%e an elimination pro#lem) Does $our cat defecate outside the litter#ox+ , N 5f $es/ ho- often does $our cat defecate outside the litter#ox+ (circle one) a) Fe- times a month #) Fe- times a -ee2 c) Dail$ d) *ultiple times dail$ 'hen is the cat most li2el$ to defecate outside the litter#ox+ 'hat percenta(e of stools are outside the litter#ox+ 'here other than the litter#ox/ does $our cat defecate+ 3ist room(s) and t$pe of surface(s):

Does $our cat urinate outside the litter#ox+ , N 5f $es/ is there a preference for urinatin( on (circle one) a) 7pri(ht surfaces/ e0(0/ -alls #) Horizontal surfaces/ e0(0/ floors c) Both upri(ht and horizontal Ho- often does $our cat urinate outside the litter#ox+ (circle one) a) Fe- times a month #) Fe- times a -ee2 c) Dail$ d) *ultiple times dail$ 'hen is $our cat most li2el$ to urinate outside the litter#ox+ 'hat percenta(e of urination is outside the litter#ox+ 'here/ other than the litter#ox/ does $our cat urinate+ 3ist room(s) and t$pe of surface(s): Ha%e $ou e%er o#ser%ed the cat soil outside the litter#ox+ 5f $es/ -hat did $ou do+ Does $our cat continue to soil outside the #ox -hile $ou are o#ser%in(+ Does $our cat e%er use its litter#ox -hile $ou are o#ser%in(+ !an $ou thin2 of an$ pattern (seasons/ da$s of the -ee2) to the pro#lem+ 'as $our pet e%er completel$ 8housetrained&+ , N 5f $es/ at -hat a(e -as the cat full$ trained+ 'hat a(e -as $our pet -hen this pro#lem started+ Descri#e the first incident: 'ere there an$ chan(es in the household -hen the pro#lem #e(an+ 'ere there an$ chan(es associated -ith the litter or litter#ox -hen the pro#lem #e(an+ 'hat do $ou thin2 caused the pro#lem+ 'hat has #een done so far to tr$ and correct the pro#lem+ 'hat -as the cat&s response+ 3ist an$ techni:ues that ha%e #een at all successful:

3ist an$ techni:ues that ha%e made the pro#lem -orse: 5s there a particular t$pe of litter or surface $our cat seems to prefer+ Are there an$ surfaces -here $our cat -ill not soil+ Ha%e $ou tried other t$pes of litter+ , N Ha%e $ou e%er used litter -ith a deodorant+ , N 5f $es/ descri#e litter and cat&s reaction to each litter t$pe: 5s there a particular t$pe of litter#ox $our cat seems to prefer+ Ha%e $ou tried other t$pes of litter#ox+ , N 5f $es/ descri#e #oxes and cat&s reaction: 5s there a particular location $our cat seems to prefer for elimination+ 5s there a room or location in $our house -here $our cat does not soil+ , N Ha%e $ou tried other litter locations+ , N 5f $es/ descri#e locations and cat&s reaction: Do chan(es (mo%in(/ ne- furniture/ %acations) dramaticall$ affect $our cat+ 3ist an$ dru(s tried so far/ and the cat&s response to medication: 3ist an$ medical pro#lems and treatment that $our cat has had: Does an$ strainin( or pain accompan$ urination+ , N Ar defecation+ , N An$ #lood in the urine or stools+ , N 5s stool consistenc$ normal+ , N 5f no/ descri#e: An$ increase in fre:uenc$: 7rine , N )tools , N Descri#e: An$ increase in drin2in(+ , N 5s there an increase in appetite+ , N

Ho- often per da$ does $our cat pass urine+ )tools+ FELINE SKIN DISORDERS Please ans-er the follo-in( :uestions if $our cat has a pro#lem -ith o%er(roomin(/ #eha%iorall$ induced hair loss (ps$cho(enic alopecia)/ ripplin( s2in (h$peresthesia)/ or self4traumatic #eha%iors Descri#e the pro#lem: 'hen did the pro#lem first #e(in+ (cat&s a(e/ time of $ear/ etc0) 'ere there an$ chan(es in the household/ -hich ma$ ha%e occurred 6ust #efore the pro#lem #e(an+ 'ere there an$ chan(es in the cat&s health or an$ other ph$sical or #eha%ioral chan(es -hen the pro#lem #e(an+ Has the se%erit$/ fre:uenc$/ pattern/ or t$pe of hair loss chan(ed since the pro#lem first arose+ , N 5f $es/ descri#e: 5s there a particular e%ent that is most li2el$ to cause or a((ra%ate the pro#lem+ 5s there a particular time of month or $ear that the pro#lem (ets -orse or #e(ins to impro%e+ 5s the #eha%ior more li2el$ to occur -hen $ou are (circle one): a) at home out of the room #) at home in the room c) a-a$ from home d) no difference 'hat has #een done so far to tr$ and correct the pro#lem+ 'hat -as the cat&s response+ 3ist an$ techni:ues that ha%e #een at all successful: 3ist an$ techni:ues that ha%e made the pro#lem -orse: 3ist an$ dru(s tried so far/ and the cat&s response to medication: Do an$ pets in $our household (o outdoors+ , N 5f $es/ -hich ones+ Do an$ other pets in the household ha%e an$ s2in pro#lems+ , N 5f $es/ descri#e:

Ha%e an$ other famil$ mem#ers or friends de%eloped s2in pro#lems+ , N 5f $es/ descri#e: PRINCIPAL COMPLAINT (it is not necessar$ to duplicate pre%ious ans-ers for elimination or s2in disorders) 'hat is the primar$ pro#lem+ (a((ressi%e/ destructi%e/ housesoilin(/ tail chasin(/ etc0) Ho- -ould $ou descri#e the se%erit$ of this pro#lem+ (circle one) a) *ild #) *oderate c) )e%ere 'hen did the pro#lem #e(in+ 'hat a(e -as $our pet -hen this pro#lem started+ Descri#e the pro#lem/ #e(innin( -ith the most recent incident: Descri#e the first incident: 'hat do $ou thin2 caused the pro#lem+ Descri#e an$ chan(es in the home or the pet&s health -hen the pro#lem first started: Ho- often does the pro#lem occur+ Has there #een a recent chan(e in fre:uenc$ or se%erit$+ , N 5f $es/ descri#e: 'hat has #een done so far to tr$ and correct the pro#lem+ 'hat has #een the cat&s response+ 3ist an$ techni:ues that ha%e #een at all successful: 3ist an$ techni:ues that ha%e made the pro#lem -orse: 3ist an$ dru(s (include dosa(e/ fre:uenc$/ -hen started/ -hen stopped)/ dietar$ treatments/ supplements/ or remedies tried so far/ and $our cat&s response to medication:

AGGRESSION 5s $our cat a((ressi%e to-ard a) famil$ mem#ers+& #) other people+& c) other cats+& d) other animals+ Descri#e: 'hat do $ou do -hen $our cat displa$s a((ression+ 'hat is the cat&s response+ FEAR 5s $our cat fearful+ , N 5f $es/ -ould $ou descri#e the fear as (circle one): a) mild #) moderate c) se%ere+ Descri#e an$ situations -here $our cat is sh$/ timid/ or fearful: Descri#e $our cat&s reaction (retreat/ freeze/ a((ressi%e/ etc0): FA" EA!H !A1E9A", !5"!3E 1HE AN)'E" 1HA1 BE)1 APP35E) )leep: a) normal #) excessi%e c) decreased d) restless -a2es at ni(ht Descri#e pro#lems: Eatin(: a) normal #) o%ereats c) %oracious d) pic2$ e) undereats Descri#e pro#lems: 7rine: a) normal #) increased amount c) increased fre:uenc$ d) decreased Descri#e pro#lems: )tools: a) normal #) increased amount c) increased fre:uenc$ d) decreased e) soft f) hard dr$ Descri#e pro#lems: Acti%it$: a) normal #) o%eracti%e . da$time c) o%eracti%e . ni(ht4time d) decreased e) repetiti%e (stereot$pic) Descri#e pro#lems: 5nteraction -ith o-ners: a) affectionate #) little minimal affection c) o%erl$ affectionate demandin( Descri#e pro#lems: ADDITIONAL PROBLEMS (descri#e #riefl$ if not pre%iousl$ discussed) Destructi%e che-in( eats plants: , N

Destructi%e scratchin(: , N )cratches people: , N !he-s suc2s non4food items: , N Vocalization ho-lin(: , N Huntin(: , N !lim#in(: , N An furniture counters -here not permitted: , N 9oes into rooms -here not permitted: , N 9ar#a(e raidin( food stealin(: , N "oamin(: , N Additional comments or pro#lems:

Landsberg G, Hunthausen W, Ackerman L 2003 Handbook of Behavior Problems of the og and !at" #aunders, $dinburgh # 2003, $lsevier #cience Limited" All rights reserved"