Cat Intake Form | Kristina's Critters

Name *

Date *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

How many cats do you have?

Cat's Name (List all) *

Cat's Name 2

Cat's Name 3

Cat's Name 4

Cat's Name 5+

List all other names here, separated by a comma.

Breed (List all) *

Breed 2

Breed 3

Breed 4

Breed 5+

List all other breeds here, separated by a comma.

Color

Color 2

Color 3

Color 4

Color 5

List all other colors here, separated by a comma.

Age of Cats now *

Age 2

Age 3

Age 4

Age 5+

List all other ages here, separated by a comma.

Weight *

Weight 2

Weight 3

Weight 4

Weight 5

List all other ages here, separated by a comma.

Sex *

Sex 2

Sex 3

Sex 4

Sex 5+

List the sex of all other cats here, separated by a comma.

Name of Veterinarian *

Name of Hospital *

Date of last veterinary exam

Date of last veterinary exam 2

Date of last veterinary exam 3

Date of last veterinary exam 4

Date of last veterinary exam 5+

List the dates of all other cats here, separated by a comma.

Any Medical Issues? *

List any current medications or supplements and which animal

List any previous behavior medications that have been tried including dose and dates when the medications were started and stopped. *

Please describe your cat’s problem behavior(s) that led you to seek out this program.

At what age did the behavior start?

How long does each incident last when it occurs? How do you respond?

How often does it occur?

Have there been any changes in the pattern, frequency, intensity, or length of incidents from the first time your cat exhibited the behavior(s) to the present? *

Are there any specific environmental conditions that trigger the behavior (who is present? What is going on in the environment before and after?) *

Can your cat be verbally or physically interrupted when engaged in the problem behavior?

Please give a detailed description of what led you to seek out help and describe the incidents. Describe three most recent incidents, more if you would like to. Note what happened before, during, and after each incident. *

How do you respond when your cat displays the problem behavior? *

Where did you get your cat(s)? *

How old was/were your cat(s) when you brought them home? *

Do you have any information about your cat’s history before you acquired her? If so, please explain. *

Do you know if your cat’s parents or siblings engaged in similar behaviors or other abnormal behaviors? *

List people living in the house with the cat(s). Include children and their ages. *

List animals in the household. Species, breed, age, sex, and whether or not they are neutered. Please indicate which of these animals were living in the house when the cat(s) were acquired. *

Describe interactions between the animals in the household when an incident is not occurring. *

Describe interactions between your cat(s) and human family members.

Describe behavior of your cat in the veterinary office during examination.

Type of food?

Frequency of feeding? Are both eating normally?

Table food/scraps/treats (list all)

Does your cat(s) have access to the outdoors?

Time spent with owner. Describe activities which take place.

Are your cat(s) declawed? If yes, what age did this occur? Front only, all 4 removed, or all claws in tact?

Describe the presence of visiting or stray cats outside your home.

Have there been any changes like a traumatic or stressful event, change to humans living in the household (moved in or moved out), remodeling, construction, stray cats visiting outside of the home, or any other environmental change or trigger?

Have any bites occurred as a result of the aggression? Has one or both of your cats had to receive veterinary attention as a result of tooth punctures?

Have you previously enlisted the help of a trainer, behaviorist, or veterinarian for help with this behavior problem?

What recommendations were you given?

Was there any improvement?

Does your cat know any trained cues? If yes, please list the trained behaviors they know the best.

How many litter boxes do you have in the house and where are they?

How many food and water sources do you have in the house and where are they?

What are three things you love about each of your cats?

What are three things you love about each of your cats? 2

What are three things you love about each of your cats?

What has led you to seek out help now?

Is there anything else you want us to know about your cat(s)?

How would your life be improved if your cat’s behavior could change?

How would your cat’s life improve if the behavior changed?

Are your prepared to commit to implementing a behavior plan daily and managing for your cat(s) for their lifetime to prevent incident?

Will all family members be on board?

Are you prepared to make an appointment with a veterinarian at any point in the process if needed to rule out underlying medical causes or have a consult about supportive medications?

Message *