Cat History

So that we may learn more information about your pet, please complete the information below prior to your appointment.

Should you have any questions, please give us a call at 506-387-4015.

OWNER INFORMATION

Client Name *

Phone Number *

Emergency Contact *

Emergency Number *

Address *

City *

Province *

Postal Code *

Client Email Address *

How did you hear about our behaviour services? *

PATIENT INFORMATION

Pet's Name *

Date of Birth *

Breed

Colour *

Sex (Spayed/Neutered) *

Date of Spay/Neuter Surgery

Declawed? *

If yes, on what date?

If yes, what method was used to declaw?

Current Weight? *

Name and e-mail or phone number of your veterinarian: *

Does your pet have any health problems? (arthritis, epilepsy, urinary tract disease, etc) *

Does your pet take medications or supplements? If yes, please specify. *

What is the primary reason for consulting? *

In your opinion, what is the severity of the problem? *

Have you considered euthanasia? *

When did you first notice the problem? *

How old was your pet when the problem started? *

How often does the problem occur? *

Describe the first time the problem behaviour occurred? *

In what circumstances does the problem behaviour occur? *

Describe the last three episodes :*

What have you tried to correct the problem? *

Are there any other problem behaviours? If yes, please specify: *

Is this your first cat? *

How old was your cat at adoption? *

How old was your cat at weaning? *

Where did you get your cat? *

Did you see your pet's parents? If yes, describe their behaviours: *

Were there other kittens in the litter? *

Were you the cat's first owner(s)? *

If not, do you know why the cat was re-homed? *

HOME ENVIRONMENT

How many people live in the home? *

How many adults? *

How many children? *

How many seniors? *

Are there any physically or mentally challenged persons? *

Name of the adults in the house: *

Name and ages of the children: *

How does the cat interact with members of the family? *

Are there any other pets in the home? Dogs, cats, other (specify). If yes, please provide the name and ages of the other pets: *

How does the cat interact with the other pets in the home? *

Does your cat go outside? *

Describe the pet's environment (single family home, apartment, fence yard etc): *

How many hours a day is your pet home alone? *

FEEDING BEHAVIOURS

How is your pet's appetite? *

Does your pet eat: *

When your pet gets their meal, does he: *

Number of meals per day *

Where does your pet eat? *

What does your pet eat? (brand and quantity) *

Do you give treats? *

What kind of treats and what frequency? *

Under what circumstances do you give your pet treats? *

Name the treats your pet prefers: *

How much water does your cat drink per day? *

SLEEPING BEHAVIOURS

Where does your cat sleep during the day? How many hours? *

Where does your cat sleep at night? How many hours? *

Does your cat wake you up at night? *

Does your cat vocalize during the night? *

ELIMINATION BEHAVIOURS

House soiling

When did this problem start?

Where? (stools)

Where? (urine)

Inappropriate Urination

How many times does the cat urinate per day? In the litter box? Outside the litter box? *

Does your cat urinate on vertical surfaces? (walls)

On horizontal surfaces?

Is it a puddle?

Stream or line?

On objects? If yes, please specify:

Inappropriate Defecation

How many stools does your cat do per day? In the litter box? Outside the box?

What is the texture of the stools?

Where does your cat usually defecate?

What is your reaction when your cat house soils?

How many litter boxes are in the home?

Where are they located?

Describe the boxes (size, cover or not, round, square, bag in the bottom etc)

What type of litter do you use?

If other, please specify:

How often do you scoop out the litter?

How often do you change the litter?

How often do you wash the litter box?

What product do you use to clean the box?

Do other pets in the house bother the cat when they are in the litter box?

Please upload pictures of the litter boxe(s) and surrounding area(s)

OTHER BEHAVIOURS

Does your cat lick his/her self? *

Does your cat chew their fur or skin? *

Does your cat exercise? If so, how often? *

What type of exercise? *

How do you play with your cat? *

What is their activity level? *

Does your cat vocalize excessively? *

In what circumstances does your cat vocalize? *

Does your cat groom excessively? *

Are there areas without fur on their body? If so, specify: *

Does your cat eat non-food items? If so, please specify: *

Does your cat chew clothing, wool, strings or shoelaces? *

Does your cat have compulsive or repetitive behaviours such as chasing their tail, suckling, skin rippling, running after shadows or other? *

Does your cat hunt? *

Does your cat kill other animals? *

Does your cat have any abnormal fears or phobias? If yes, please specify: *

Is your cat abnormally shy? *

How does your pet react to the following situations?

When you pet them? *

When you pick them up? *

When you brush or comb them? *

When you go to the groomer? *

When you clip their claws? *

When you go to the veterinarian? *

When a stranger enters the house? *

When a person they know enters the house? *

Reaction to young children? *

Reaction to older children? *

Reaction to elderly people? *

Reaction to loud noises? *

Are there any other behaviours that your pet does that concern you?

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

Cat History

OWNER INFORMATION

PATIENT INFORMATION

HOME ENVIRONMENT

FEEDING BEHAVIOURS

SLEEPING BEHAVIOURS

ELIMINATION BEHAVIOURS

Inappropriate Urination

Inappropriate Defecation

OTHER BEHAVIOURS

How does your pet react to the following situations?

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