Feline Behavior Questionnaire

Pet Name:*

Breed*

Color*

Pet Birthdate:*

Weight (if known)*

Sex:*

Female

Female, Spayed

Male

Male, Neutered

If not neutered, reasons for not neutering (check all that apply):

Show dog

Plan to breed

Health concerns

Other

Date of last Rabies vaccination (specify 1-year or 3-year vaccine)*

People living in the household (include name, age, relationship to you, describe basic relationship to patient)*

1.
2.
3.
4.
5.
6.

Other people in regular contact with the pet (e.g., pet sitters, housekeepers, relatives, friends, etc.). Please provide name, age, relationship.*

1.
2.
3.
4.
5.

Other pets in the household (in order they came into the household). Please provide name, species, breed, gender, age now & age when obtained, and describe basic relationship with patient.*

1.
2.
3.
4.
5.

How long have you had this cat?*

How old was this cat when acquired?*

Where did you obtain this cat?*

Show breeder

Hobby breeder

Private home/previous owner

Shelter/rescue organization

Pet store

Other

Has the cat had other owners?*

Yes

No

If yes, how many?

If yes, reasons for surrender?

Have you ever had cats before?*

Yes

No

Why did you acquire this cat? (check all that apply):*

Adult's pet

Family pet

Children's pet

Companion to other pet

Show

Breeding

Other

Did you meet this cat’s parent’s or littermates?*

Yes

No

Do you know if the parents or littermates engaged in similar behaviors as this patient?

Yes

No

Don't know

If yes, what behaviors are similar?

How does your cat react to strangers?*

How does your cat behave in a crate?*

How does your cat behave in veterinary offices and while being examined?*

At what age was your cat neutered/spayed (if applicable)? (provide age and date of procedure)*

If your cat is “intact,” has he/she ever been bred?*

Yes

No

Unsure

Are you planning to breed?*

Yes

No

Is your cat declawed?*

Yes

No

If so, which feet?*

Front Feet

Back Feet

All four

Age when declawed, if known:

Is your cat on flea preventive? (please list product)*

Has your cat been on behavioral medication in the past?*

Yes

No

If so, please explain:

List any major illnesses/surgeries (dates):*

List ALL medications/treatments your cat is currently receiving, including heartworm, flea preventative, dietary supplements, and herbal/homeopathic treatments (provide name of medication, dosage/frequency given, and date started):*

1.
2.
3.
4.
5.
6.

Type of House:*

Single-family detached

Apartment

Attached/Townhouse

Mobile home

Other

How many stories does the cat have access to?*

Has your household changed since acquiring this cat? If yes, how?*

Neighborhood:*

Urban

Suburban

Rural

Does your cat have access to the outdoors? If yes, describe (for example: walks on harness, on deck only, free access, etc.)*

How many hours total does your cat spend outdoors. on average, per day?*

Does your cat have access to the outside through a cat door?*

Yes

No

If kept indoors, is your cat restricted to a specific area or room in the house? Please describe.

How many times do you play with toys or play games with the cat, daily (on average)?*

How long does each play bout last, on average (in minutes)?*

When and where is the cat fed?*

How many meals is your cat fed each day?*

Who feeds the cat?*

Amount of food per meal?*

What is your cat’s favorite treat or human food?*

Types of food:*

Dry (brand and % of diet)
Canned (brand and % of diet)
Raw (ingredients and % of diet)
People's food (type and % of diet)
Treats (brand and % of diet)

Eating habits (check any that apply):*

Eats right away

Picky eater

Anxious eater

Social eater

Guards food from cats

Other

Please complete the table below. Check all that apply*

	Hides	Escapes	Urinates	Defecates	Dilates pupils	Hisses	Vocalizes	Puffs up (fur/tail)
Cat is home with family
Cat is alone at home or separated from family
Visitor enters home
Visitor approaches/ interacts with cat
Another household cat approaches
Household dog approaches
At veterinary office
At groomer’s
Owner is cleaning/ decorating/
renovating
New object is in the home
Loud noises
Unfamiliar animal approaches

The following chart provides information about aggression, its intensity, and in what situations it is elicited.

For each situation listed, check your cat’s worst reaction in the past. These questions refer to situations in the past. Please do not do these things to determine your cat’s reaction. If he or she has never been in a particular situation, please check “situation does not apply”.*

	No aggression	Growls, swats, shows other aggressive behavior without biting	Bites (makes contact)	Situation does not apply
Family member stares at cat
Family member reaches toward or bends over cat
Family member pets cat
Family member hugs/kisses cat
Family member lifts cat
Family member approaches cat while resting
Family member pushes/pulls cat (e.g., off furniture)
Family member enters or leaves room cat is in
Family member approaches/disturbs cat while eating
Cat’s ears or eyes are cleaned or treated
Cat’s nails are trimmed
Cat is brushed/combed
Dog approaches cat while eating
Another cat approaches cat while eating
Cat encounters other cat near the litter box
Another cat approaches/disturbs cat while resting
Dog approaches/disturbs cat while resting
Cat approaches another household cat who is resting
Cat approaches another household cat who is eating
Cat is in the waiting room
Veterinarian/staff member handles/examines cat
Cat is removed from or put back in carrier
Cat is verbally scolded or yelled at
Cat is physically punished (hit)
Response to strangers
Unfamiliar person (adult) approaches cat
Unfamiliar person (adult) speaks to/pets cat
Unfamiliar child approaches or interacts with cat
Response to infants or toddlers
Unfamiliar person approaches/passes window while cat is indoors
Unfamiliar cat approaches/passes window while cat is indoors
Unfamiliar cat approaches/interacts with cat outside
Unfamiliar dog approaches/passes window while cat is indoors

Please check the appropriate box for each situation:*

	0	1	2	3	4	5	+5
If your cat has ever bitten anyone, please indicate the total number of bites:
Please indicate the number of bites that broke skin:
Please indicate the number of bites reported, and to whom: (i.e., local authorities, hospital, humane society, etc.)

Reported to:

Was there legal action taken against the owner as a result of the bite(s)?*

Yes

No

How many litter boxes do you have?*

0

1

2

3

4

5

6

>6

Describe the litter boxes (please check all descriptions that apply to each box):*

	Box 1	Box 2	Box 3	Box 4	Box 5	Box 6
Open
Covered
Large
Small
Deep
Shallow
Liner (unscented)
Liner (scented)
No-liner
Litter material*
Location

What kind of litter material is used in the box(es)? (Please check all that apply):*

Plain clay

Clumping / scoopable

Playground sand

Gravel / rock

Sawdust / woodchips

Newspaper- recycled / pelleted

Newspaper- shredded or paper towels

Potting soil

Pine shavings

Wheat

Deodorized

Cheapest

None (empty box)

Other

Describe, in detail, how your cat uses the litter box. For example, does he or she scratch in the litter before eliminating? Cover up feces? Scratch outside the box?*

Answer all of the following:*

How frequently is the urine or feces scooped?
How frequently is the litter entirely changed?
How frequently is the litter box washed and the contents replaced?
Are deodorants such as bleach or Lysol used in the cleaning process?
Will the cat immediately use a freshly cleaned litter box?

Answer the following:*

	Yes	No	Unsure
Will the cat eliminate in the presence of other animals or people?
Does the cat ever vocalize while it eliminates?
Does the cat ever run out of the box after eliminating?
Does your cat ever eliminate outside the box, in the house?

If your cat eliminates outside the box, does he or she:

Urinate

Defecate

Both

How do you clean up afterwards (include product(s) used)?*

Where are the litter boxes located?*

Where does your pet sleep?*

Is your cat very active at night? If yes, explain:*

Describe the very first incident of this problem. Try to remember the earliest occurrence of the problem, even if it wasn't as serious as it is now.

Include where the incident occurred, who else (human and animal) was present, what happened just before the incident, and how everyone reacted. Also include the date of the event and the cat's approximate age.*

Describe the most recent incident of this problem.

Include where the incident occurred, who else (human and animal) was present, what happened just before the incident, and how everyone reacted. Also include the date of the event and the cat's approximate age.*

Describe at least one other incident you feel illustrates the problem behavior. Try to remember the earliest occurrence of the problem, even if it wasn't as serious as it is now.

Include where the incident occurred, who else (human and animal) was present, what happened just before the incident, and how everyone reacted. Also include the date of the event and the cat's approximate age.*

How have the problems progressed over time? For example, “the cat occasionally urinated on carpet at 2 years of age, but stopped using the box entirely a year later.”*

Has the frequency or the intensity of the occurrence of the behavior changed since the problem started? If so, how and when?*

How frequently does this problem occur?*

>10 times/day

1-10 times/day

1-6 times/week

<1x/week

>1time/month

Is the frequency…*

Increasing

Decreasing

Unchanged

Describe what you've tried to correct the problem and what the cat's response has been to each attempt.*

How serious do you and other members of the household find this problem:*

	Mild	Moderate	Severe	Intolerable
You
Person 1
Person 2
Person 3
Person 4

Please answer the following:*

	Yes	No
Have you considered finding another home for this pet?
Have you considered euthanasia (putting your pet to sleep)?
Did someone recommend euthanasia before your visit here?

Feline Behavior Questionnaire

Patient

Pet Name:*

Breed*

Color*

Pet Birthdate:*

Weight (if known)*

Sex:*

If not neutered, reasons for not neutering (check all that apply):

Rabies Vaccination Status:

Date of last Rabies vaccination (specify 1-year or 3-year vaccine)*

Household Information

People living in the household (include name, age, relationship to you, describe basic relationship to patient)*

Other people in regular contact with the pet (e.g., pet sitters, housekeepers, relatives, friends, etc.). Please provide name, age, relationship.*

Other pets in the household (in order they came into the household). Please provide name, species, breed, gender, age now & age when obtained, and describe basic relationship with patient.*

Acquisition Information

How long have you had this cat?*

How old was this cat when acquired?*

Where did you obtain this cat?*

Has the cat had other owners?*

If yes, how many?

If yes, reasons for surrender?

Have you ever had cats before?*

Why did you acquire this cat? (check all that apply):*

Did you meet this cat’s parent’s or littermates?*

Do you know if the parents or littermates engaged in similar behaviors as this patient?

If yes, what behaviors are similar?

How does your cat react to strangers?*

How does your cat behave in a crate?*

How does your cat behave in veterinary offices and while being examined?*

Medical History:

At what age was your cat neutered/spayed (if applicable)? (provide age and date of procedure)*

If your cat is “intact,” has he/she ever been bred?*

Are you planning to breed?*

Is your cat declawed?*

If so, which feet?*

Age when declawed, if known:

Is your cat on flea preventive? (please list product)*

Has your cat been on behavioral medication in the past?*

If so, please explain:

List any major illnesses/surgeries (dates):*

List ALL medications/treatments your cat is currently receiving, including heartworm, flea preventative, dietary supplements, and herbal/homeopathic treatments (provide name of medication, dosage/frequency given, and date started):*

Environment

Type of House:*

How many stories does the cat have access to?*

Has your household changed since acquiring this cat? If yes, how?*

Neighborhood:*

Does your cat have access to the outdoors? If yes, describe (for example: walks on harness, on deck only, free access, etc.)*

How many hours total does your cat spend outdoors. on average, per day?*

Does your cat have access to the outside through a cat door?*

If kept indoors, is your cat restricted to a specific area or room in the house? Please describe.

How many times do you play with toys or play games with the cat, daily (on average)?*

How long does each play bout last, on average (in minutes)?*

Daily Activities and Routine:

When and where is the cat fed?*

How many meals is your cat fed each day?*

Who feeds the cat?*

Amount of food per meal?*

What is your cat’s favorite treat or human food?*

Types of food:*

Eating habits (check any that apply):*

Fears and Anxieties

Please complete the table below. Check all that apply*

Aggression Screen for Cats

Bite History

Please check the appropriate box for each situation:*

Reported to:

Was there legal action taken against the owner as a result of the bite(s)?*

Elimination Behavior

How many litter boxes do you have?*

Describe the litter boxes (please check all descriptions that apply to each box):*

What kind of litter material is used in the box(es)? (Please check all that apply):*

Describe, in detail, how your cat uses the litter box. For example, does he or she scratch in the litter before eliminating? Cover up feces? Scratch outside the box?*

Answer all of the following:*

Answer the following:*

If your cat eliminates outside the box, does he or she:

How do you clean up afterwards (include product(s) used)?*

Where are the litter boxes located?*

Where does your pet sleep?*

Is your cat very active at night? If yes, explain:*

Describe the most recent incident of this problem.

Include where the incident occurred, who else (human and animal) was present, what happened just before the incident, and how everyone reacted. Also include the date of the event and the cat's approximate age.*