Cat Behavior Helpline Form

Name (first and last):*

Phone:*

Email:*

Cat's Name*

Address*

City State / Province / Region ZIP / Postal Code

Behavior Concerns (select all that apply):

Thorough Description of Behavior Concerns*

How long has the problem been occuring?

How often does the problem occur?

Did any changes to the household or cat's health occur immediately before the problem began?

What have you tried to resolve this issue?

Resident Cat/s Information

Please provide as much detail as you can for each cat in the home. Recommended details include: – Name – Age – Sex – Breed – Spayed, Neutered, or Intact – Declawed Yes or No – Time in the Home – Where Aquired – Indoor Only, Outdoor Only, or Indoor/Outdoor – Month and Year of Last Veterinary Visit – Primarily Attached To (person) – Personality (shy, outgoing, playful, etc.) – What you enjoy about the cat

Household: Humans

How many people live in the home or regularly visit? Include ages for any children in the home and their relationship with the cat.

Household: Pets

List all animals who live in the home or regularly visit. Include ages, breeds, and their relationship with the cat.

How often do you play with your cat/s?

Can the cat/s see other animals outside a window or have access to other unfamiliar animals outside?

Other Relavant Information:

Describe your goals and expectations for your cat's behavior:

Medical History

Have you taken your cat/s to the vet for this problem? If yes, when and what were the veterinarian's findings?

Is your cat currently under any medical treatment?

Past medical issues:

Additional House Soiling Information

Does your cat potty in specific locations or on certain materials?

How often does this behavior occur?

What cleaning products have you tried?

How many litter boxes are in the home?

Where are the litter boxes located?

Does the cat use any of the litter boxes?

Type of Litter (brand, scented/unscented, substrate):

How often do you change brands of litter?

Type and description of the litter boxes:

How often do you scoop each box?

Do you use box liners?

How often do you deep clean the boxes?

Does your cat cover the waste in the box?

Does your cat scratch outside of the box?

Does your cat straddle the box?

Does your cat bolt/rush out of the box once finished?

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Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name

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