Behaviour Intake Questionnaire

This questionnaire will take 15-25 minutes to complete. If you would prefer to complete it over a number of sittings, please download the Word version below.

BEHAVIOUR QUESTIONNAIRE - WORD VERSION DOWNLOAD

Please answer the questions as thoroughly as possible. The more information you can provide, the easier it is to correctly diagnose and treat the problem behaviour.

Name*

First

Last

Address (including suburb and postcode)*

Phone*

Email*

1/5

Name of cat(s)*

Breed(s)*

Age(s)*

Sex*

Desexed (Y/N)*

Weight(s)*

Indoor/Outdoor/Both*

Please describe your cat's temperament/personality (e.g. timid, cautious, playful, confident)

2/5

Does your cat have any known medical conditions?*

When was your cat's last vaccination and check-up?*

When and where did you get your cat?*

How old was your cat when you got him/her?*

Do you know your cat's early history (e.g. age weaned, was he/she socialised properly etc)? Please explain*

3/5

Please describe the problem in as much detail as possible*

When did the problem start happening?*

How often does the problem occur?*

What have you tried already to fix the problem?*

4/5

Please list all other inhabitants of the household, including both animals and humans. Please include name, breed, age, sex etc.*

How long is your cat left alone each day?*

How many cat trees and scratching posts do you have in the house, and where are they located?*

How many litter trays do you have in the house, and where are they located?*

How often do you (a) scoop, and (b) replace the litter?*

Do you free-feed (have food available all the time) your cat, or adhere to set meal times?*

How many food bowls do you use and where are they located?*

How many water bowls do you use and where are they located?*

What do you feed your cat? Please indicate whether this is wet or dry food.*

Do you play with your cat? How do you play and how often?*

Has there been any recent changes in the household that may have triggered or coincided with the behaviour (e.g. new baby, new housemate, move house, renovations etc)?*

Do you have any other comments or insights that may help with diagnosing or correcting the behaviour?*

5/5