This form should be completed by the person over 18 who spends most time with the cat. Please discuss your responses with the whole family and indicate any areas of disagreement between individuals. Please include as much information as possible.
Title Surname First name
Date form completed:
Your cat’s name:
Is your cat insured? YesNo
Renewal date:
Address:
Post code:
Telephone Number(Day)
Telephone Number(Evening)
Telephone Number(Mobile)
Email
Please describe in a few words, the nature of the problem(s) causing concern? (We will ask for specific details later) and how it is impacting on you and others.
Briefly describe what you hope to achieve for your cat with our support
What previous experience do you have with cats?
Briefly explain the reason for obtaining the animal for whom you would now like help.
Is your pet currently on any medications or supplements etc. (such as dietary supplements or herbal products)? If yes, please list name and dosage.
Has your pet been on medication for his/her behaviour in the past? If yes, please list name and dosage.
Known medical history (especially recurrent problems) Please attach a history from your vet if necessary. Uploaded files must be PDF, JPG or PNG and 2MB or less in size:
ABOUT YOUR CAT Age:
Date of birth if known:
Age when obtained:
Breed (if cross, indicate predominant breed or type if known):
Sex (please mark the appropriate boxes): MaleFemale NeuteredIntactNot Sure
Vaccination status (incl. date last vaccinated):
Date last wormed:
Problem – please detail what the problem is and rank it in order of importance:
How long has it been present and how old was the pet when it began?
Can you identify any specific event or trigger which started the problem?
Where and with whom / in what situations does it occur now?
Is the problem better or worse in certain circumstances or with certain individuals, or have you noticed a particular pattern to the behaviour, please give further details here?
How frequently do you encounter the problem? (Times per day, per week, per month or per year)
Please describe the first incidence of the behaviour that you can recall, the most recent and the one which you remember best, i.e. 3 incidents in total, focusing specifically on what happened before the behaviour, what your cat did exactly and what happened afterwards, including how others reacted to the cat’s behaviour.
First incident:
Most recent incident:
Incident remembered best:
What has been done to correct the problem? Please indicate whether each measure has helped, made no difference or made matters worse
Is the problem getting BetterWorseNo Change
Do you suspect any cause?
Any other details of the complaint that you would like to share with us?
Type of home (i.e. flat, etc):
Degree of access by cat:
Does your cat have access to a garden? yesNo
How does your cat access the outdoors?
When outdoors, how does your cat re-enter the house?
If yes, is this access: ControlledFree or Cat Flap
If you have a cat flap, is it, controlled (e.g. with a magnetic or microchip collar), so only your cat(s) can use it? MicrochipMagneticNo Control Device
Please list other household pets, names, species, ages, gender and whether they are spayed or neutered. Name,Species,Age,Gender / Neutered
Please list names and ages of other family members who live at home and how you would describe the relationship of each family member with your cat:
Name,Age,Relationship with cat
Please provide a floor plan of your home. Indicating entrance and exit points as well as resources (e.g. beds and feeding areas, water areas, scratch posts, litter trays). Uploaded files must be PDF, JPG or PNG and 2MB or less in size:
]
Do you have a litter box? YesNo
If yes, how many?
What type (covered, uncovered, shape, size – please measure width and length and access side height)?
Where are the litter boxes in the home?
What type of litter / liner do you use?
Always the same make? YesNo
Please list types used in the last 2 months:
How often is the litter box cleared of excrement and topped up with fresh litter as necessary?
How often completely cleaned out (i.e. washed and all litter replaced)?
If you have more than one cat, please provide the following details:
Please describe how / where all cats are fed e.g. separate bowls in different rooms, one communal bowl etc.
How many water bowls do you have and where are they located:
How many beds or sleeping areas are there in your house? Please describe them and their locations:
Please give details of which cats, if any, will share sleeping areas with each other:
How would you describe the relationship between the individual cats in your home? Please give details of which cats, if any, will groom each other or which cats avoid each other, for example.
Do your cats play together? Which ones? Who initiates play, or who chases who when playing?
Do any of your cats hiss at each other? Which ones?
Feed type: WetDry/Moist
Food provision: Ad Lib4 or more meals a day2-3 meals a day1 a dayless than 1 a day
If your cat is fed meals, does your cat tend to eat it all up at a single sitting? YesNo
Is your cat fed from Food BowlFood DispenserScatter feed trayOther If Other , please describe
Fed by whom:
Does your cat prefer to eat or drink in a particular area?
How would you describe your cat’s appetite:
What is your cat’s favourite food?
Please list any supplements, treats or titbits which your cat receives:
Source:
Please indicate age of weaning if known:
Details of early life, if known, including litter size, early illness, rehoming etc
How was your cat housetrained? Please include how long it took to housetrain your cat.
How did you treat mishaps at this time?
Have you ever bred from this cat? YesNo If yes, at what age?
How do you correct your cat when s/he behaves in a way you do not like?
What do you do when your cat behaves in a way you like?
If your cat does any tricks, please give some details of them here
Please rate your cat’s personality on a score of 1-10 for each of the following traits, where 1 is the lowest level and 10 the highest level of that trait you can imagine being in an animal
Extraversion
Motivated
Friendly/sociable to others including people
Anxious
Angry
Would you describe your cat as moody/ having a Jekyll and Hyde type character? YesNo
How would you describe your cat’s personality?
Does your cat have any known fears or things it dislikes?
When does your cat: Meow
Growl
Purr
Other
What is your cat’s favourite pastime?
Does your cat tolerate, enjoy or resist the following (please tick the appropriate boxes): Handling TolerateEnjoyResist
Grooming TolerateEnjoyResist
Does your cat groom itself a lot? YesNo
If yes, where and indicate if this is at any particular time?
What are the feelings of each family member about your pet’s present behaviour?
What are the essential changes you need to be able to continue to live with your cat?
Under what circumstances would you consider euthanasia?
Please give any other information you think relevant to the case:
Is there any sort of aggression (growling, hissing, snarling, biting) in the following circumstances? Please complete the chart below: (Y-Yes, N-No, ?- Don’t Know. If yes, indicate what type from the list above)
When handling/grooming Adult Females YesNoDon't Know If yes, what type of aggression is shown N/AGrowlingHissingSnarlingBiting
Adult Males YesNoDon't Know If yes, what type of aggression is shown N/AGrowlingHissingSnarlingBiting
Children YesNoDon't Know If yes, what type of aggression is shown N/AGrowlingHissingSnarlingBiting
Any Specific IndividualYesNoDon't Know If yes, what type of aggression is shown N/AGrowlingHissingSnarlingBiting
If disturbed when resting Adult Females YesNoDon't Know If yes, what type of aggression is shown N/AGrowlingHissingSnarlingBiting
If disciplined Adult Females YesNoDon't Know If yes, what type of aggression is shown N/AGrowlingHissingSnarlingBiting
When petting or hugging Adult Females YesNoDon't Know If yes, what type of aggression is shown N/AGrowlingHissingSnarlingBiting
Other Adult Females YesNoDon't Know If yes, what type of aggression is shown N/AGrowlingHissingSnarlingBiting
If you answered yes to any of the above, please complete the next section
Describe the most recent incident and the setting in which it occurred. Try to be as precise as possible, imagine you are drawing a picture.
Where was your cat?
Where was everyone in relation to your cat?
What was everyone doing before the incident?
What did your cat do exactly and what did he look like just before and after the event?
Are you aware of a trigger for the behaviour or for similar behaviour in the past?
Were you aware of any warning signs before the incident?
What was your immediate reaction?
What was the reaction of the victim?
How did your cat respond to this reaction?
If there was a bite wound, where was it located on the body and what kind of a wound was it (scratch(es), puncture wound, tear, blue spot, etc)?
Does your cat treat all members of the household in the same? Please give details of any differences.
Please list below and rank the five edible things your cat is most fond of (rank 1st favourite) 1. 2. 3. 4. 5.
Please list below and rank the five toys/ games or items your cat is most fond of (rank 1st favourite) 1. 2. 3. 4. 5.
How frequently are they used?
For how long are they played with at a given time?
If you play games with your cat, please give some details of them here
Describe a typical 24 hours in your cat’s life
Does this routine change at any time (e.g. weekend compared to weekday). If yes, please specify how.
How much time does your cat spend outdoors each day?
Where can your cat normally be found during the day?
Does your cat have bouts of explosive activity? If so, when?
Is your cat very active at night?
Where does your cat sleep?
What arrangements are made for the cat if you are away from home for an extended time, e.g. on a holiday?
Does your cat have a scratch post? YesNo
Please describe e.g. length and materials:
Does your cat show any sexual behaviour, normal or abnormal?
Thank you for taking the time to complete this form. Once received, we will contact you to arrange a convenient appointment. Please be patient the submission process can take several seconds to complete.
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