Feline Behaviour Questionnaire

Date of Consult *

MM

DD

YYYY

Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Family Veterinarian *

First Name

Last Name

What is the primary reason for your visit? *

Soiling/marking on horizontal surfaces

Soiling/marking on vertical surfaces

Scratching

Vocalization

Aggression

Fear/anxiety

Other

Has there been a recent change in frequency or severity? *

Yes

No

Have you ever used any of the following with your cat? *

Select all that apply

Physical punishment (jabs, hitting, etc.)

Shaker cans

Sirens

Ultrasonic devices

Water sprayer

Citronella spray

Booby traps

Repellents

None

Do you consent to having photos or videos of your pet shared for educational purposes? *

Yes

No