Feline History - Cat's Pajamas Consulting

Feline History and Behavior Intake

First Name*

Last Name*

Address*

Phone*

Additional Phone

Email*

Hours a day you are home*

Cat's Name*

Age

Breed

Sex*

Male

Male Neutered

Femal

Female Spayed

Declawed*

No

Front Only

All Four

Is this your first cat?*

Yes

No

Had Cats growing up

Where did you get your cat?*

How long have you had your cat?*

Any previous history that you know?*

Please describe behavior you wish to resolve*

When did you first notice a behavior change*

Is the behavior predictable? please explain*

How often is the behavior occurring?*

Have you ever had this behavior with another pet?*

Yes

No

Any changes to your home lately?*

What steps have you taken to prevent behavior *

How often do you interactively play with your cat*

Please list all pets. (age, sex, breed, species)

Indoor/Outdoor*

Indoor Only

Walks On Leash

Indoor/Outdoor With Supervision

Indoor/Outdoor Unsupervised

Please list other household members name and age*

Have you considered any of the following *

I Will Do Whatever it Takes

I Have/am Considering Giving Up The Pet

Undecided

How do you praise your cat*

How do you reprimand the cat*

Have you sought advice for this behavior before*

Yes

No

Please describe the typical day for your cat*

Please describe playtime with the Cat*

Do you have pet insurance *

Yes

No

Name of Vet*

How would you describe your cat at the vet*

Normal/Doesn't mind

Enjoys the Adventure

Fearful/Shy

Doesn't Like It/Hissing, Swat or Growl

Date of last visit to the vet*

Did your vet give you recommendations *

Current or Past medical issues or injuries *

Please list any medications or supplements *

Please list sensitivities to food or allergies *

Food brand*

Describe feeding *

Is cat urinating or defecating outside of the box*

Yes

No

What elimination is occurring INside the box

What material is cat soiling on

Where is your cat eliminating

Floor Within 1ft. Of Box

Floor More Than 1ft From Box

On Or Near Windows Or Doors

Area Where Family Spends Majority of Time

Hidden Area (Under Bed, Closet, Etc)

In Front of Human

Other

Have you noticed any cat discomfort eliminating

Yes

No

How many litter boxes do you have*

Litter box locations

Type of box

Type of litter

Litter style

How often do you scoop

How often you fully empty box and replace litter

How would you describe the elimination

Large Urine Puddles On Flat Horizontal surfaces

Small Urine Puddles On Flat Horizontal Surfaces

Urine On Vertical Surfaces Such As Walls

Feces Is Soft (Like Soft Serve Ice Cream)

Feces Is Firm (Like A Soft Tootsie Roll)

Feces Is Hard, Dry (Like An Old Tootsie Roll)

Is your cat scratching your belongings*

No

Yes, And I Want It To Stop

Yes, And I Dont Care

How many scratching posts do you have *

What is the scratcher made of

Where are the scratchers located

What style are the scratches

Upright

Door Hanger

Mounted On Wall

Horizontal

How often does the cat use the scratcher

Regularly

Sometimes

Rarely / Never

I've Never Seen The Cat Go Near It

What is being scratched that you don't like

Does your cat have a nail care regimen

No

Yes, I Trim

Yes, I Grind

Yes, I Have My Vet/Groomer Do It

Is your cat displaying aggression *

Yes

No

Describe the aggression

Bite/ No Skin Broken

Bite - Skin Broken

Multiple Bites Breaking Skin

One Or A Few Light Scratches That Barely Bleed

One/ Few Scratches That Bleed

Multple Scratches That Bleed

Where is the aggression directed

When does the aggression occur

Anything else important you want to say

I understand media sharing agreement*

Check the box if true

I understand 24 cancellation policy*

Check the box if true

I understand "no show" policy*

Check the box if true

I understand this file will be shared with my vet*

Check the box if true