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(Office Use) Case Ref ________________
Feline Behaviour Questionnaire / Terms & Information
Obtaining the following information prior to meeting allows best use to be made of the consultation
time. Please be as accurate as possible and if necessary, expand answers separately. Please email this
questionnaire to [email protected], or post it to Park House, 30 Albany Road, Fleet,
Hampshire, GU51 3LY.
General Information
Client Name(s): _____________________
Referring Veterinary Surgeon: _________________
Address: __________________________
Cats Name: ________________________________
__________________________________
Breed: ____________________________________
__________________________________
Sex: M / F
Postcode: __________________________
Neutered: N / Y - aged: _________ (Yrs / Months)
Tel(s): _____________________________
Age: ________________________ (Yrs / Months)
E-mail Address: ______________________
Age Obtained: _________________ (Yrs / Months)
Please describe your cats temperament: __________________________________________________
Have you owned a cat before: ____________________ If yes, which breed: ____________________
Early History
Where did you get your cat from? _________________________ No. previous owners’ ___________
Please describe previous environments, i.e. family home, outdoor cattery, farm, children, other pets,
hand-reared: _______________________________________________________________________
If from a rescue organisation, how long was he/she there? _________ What were the reasons for rehoming? __________________________________________________________________________
Why did you choose this individual or breed? _____________________________________________
Health Status
Does your cat have current or previous health problems? ____________________________________
Is your cat given medication, herbal remedies or food supplements?____________________________
Has your cat ever been bred from (if so, please provide details)? ______________________________
Deborah Fry BSc (Hons) MSc www.animalbehaviourconsult.co.uk
[email protected]
Tel: 01252 629836
FBQ Pg 1/6
Present Household
Please list human household members, detailing age and involvement with the cat concerned:
Name
Age
Involvement with Cat
___________________________
________
____________________________________
___________________________
________
____________________________________
___________________________
________
____________________________________
___________________________
________
____________________________________
___________________________
________
____________________________________
Who else is involved with the care of your cat, e.g. sitters, groomers, boarding facilities?
Name
Involvement with Cat
___________________________
_________________________________________________
___________________________
_________________________________________________
Please list all other pets within the household:
Name / Species Breed
Age
M/F
Neutered
Date Joined Household
___________________
____
____
_______
_____________________________
___________________
____
____
_______
_____________________________
___________________
____
____
_______
_____________________________
___________________
____
____
_______
_____________________________
Please describe the relationship(s) between household pets: __________________________________
__________________________________________________________________________________
Daily Routine
How long is your cat typically left alone on a weekday / weekend? ____________________________
Does he/she settle when left alone? _____________________________________________________
Where in the household does he/she stay when left alone? ___________________________________
Where does he/she sleep during the day? _________________________________________________
Where does he/she sleep at night? ______________________________________________________
Is your cat particularly active at night? __________________________________________________
Does he/she ever wake you at night? ____________________________________________________
Does your cat seek out high places to rest? _______________________________________________
Where does your cat tend to go to the toilet? ______________________________________________
Does he/she follow any particular person around the house? _________________________________
Deborah Fry BSc (Hons) MSc www.animalbehaviourconsult.co.uk
[email protected]
Tel: 01252 629836
FBQ Pg 2/6
Please describe a typical 24 hr period for your cat: _________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
___________________________________________________________________________
Diet
What type / brand of food is your cat fed? ________________________________________________
What type / brand of treats are given, & how often? ________________________________________
How many time a day is he/she fed, & at what times? ______________________________________
Do you include supplements (please describe)? ____________________________________________
Where is your cat fed? _______________________________________________________________
Who feeds your cat? _________________________________________________________________
Does changing his/her food affect behaviour? _____________________________________________
How many food & water bowls are provided within the home? _______________________________
Do you notice your cat drinking water often? _____________________________________________
Exercise
Please describe your home, i.e. house, apartment, ground-floor etc: ____________________________
Does your cat have access to a garden (free access or restricted)? _____________________________
(Where applicable) Does your cat access the garden via a cat-flap? ____________________________
(Where applicable) Approximately how much time is spent outdoors daily? _____________________
(Where applicable) Does your cat frequently catch prey? ____________________________________
(Where applicable) Please describe your garden boundary, i.e. wall, fence, cat-proofing: ___________
__________________________________________________________________________________
(Where applicable) Does your cat choose to stay within the garden boundary? ___________________
Do other cats visit your garden, or are they regularly seen through windows? ____________________
__________________________________________________________________________________
(Where applicable) How does your cat react when he/she sees visiting cats? _____________________
__________________________________________________________________________________
If your cat roams, how far on average? __________________________________________________
If roaming, does your cat stay away from home for any significant time period? __________________
Does your cat play with toys? _________ What types? _____________________________________
Who initiates play: people or your cat? __________________________________________________
Does your cat use or have access to scratch posts (please describe): ____________________________
__________________________________________________________________________________
Deborah Fry BSc (Hons) MSc www.animalbehaviourconsult.co.uk
[email protected]
Tel: 01252 629836
FBQ Pg 3/6
Training
Have you ever trained your cat? ________ If so, please describe outcomes / methods: _____________
__________________________________________________________________________________
Has any training equipment ever been used? ______________________________________________
Have you ever involved another behaviourist: ________ If so, please provide details: _____________
__________________________________________________________________________________
Elimination Behaviour
Does your cat use a litter tray? ______ If so, is this for urine, faeces, or both? ___________________
(Where applicable) Does your cat bury it faeces / urine within the litter tray? ____________________
Does your cat ever eliminate outside of the litter tray? ______________________________________
How many litter trays are within the home? _____ What type (covered / uncovered): ______________
Where are the litter trays located within the home?_________________________________________
What litter material is used? ___________________________________________________________
Do you always use the same litter type / brand? ___________________________________________
How often is the litter replaced and the tray cleaned? _______________________________________
What cleaning solution is used to clean the tray? __________________________________________
Behaviour Causing Concern
Please describe the behaviour(s) causing concern. If more than one, please specify the order of concern
you place them in: __________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
When does this behaviour occur? _______________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Is the behaviour directed at a particular individual? ________________________________________
__________________________________________________________________________________
Who is usually present at the time? _____________________________________________________
__________________________________________________________________________________
What happens immediately before these behaviours are displayed? ____________________________
__________________________________________________________________________________
__________________________________________________________________________________
Deborah Fry BSc (Hons) MSc www.animalbehaviourconsult.co.uk
[email protected]
Tel: 01252 629836
FBQ Pg 4/6
Please describe how you / others react, or have reacted, to the behaviour: _______________________
__________________________________________________________________________________
__________________________________________________________________________________
When did this behaviour first occur? Please describe the first incident: _________________________
__________________________________________________________________________________
__________________________________________________________________________________
Are you aware of any change in circumstances / trauma for your cat around this time? _____________
__________________________________________________________________________________
__________________________________________________________________________________
Has the frequency / severity of this behaviour since increased? _______________________________
__________________________________________________________________________________
Please describe the last incidence: ______________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Are you aware of related pets having behavioural / medical problems? _________________________
__________________________________________________________________________________
Do other pets he/she has contact with display similar behaviours? _____________________________
___________________________________________________________________________
Please describe previous methods used to resolve this issue: _________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
What action would be considered if the behaviour continued? ________________________________
__________________________________________________________________________________
Does your cat ever display aggression? Please describe: _____________________________________
__________________________________________________________________________________
__________________________________________________________________________________
How does your cat react to visitors, children and strangers? __________________________________
__________________________________________________________________________________
Please describe scenarios which cause your cat anxiety, i.e. vet visits, grooming, loud noises, visitors:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Deborah Fry BSc (Hons) MSc www.animalbehaviourconsult.co.uk
[email protected]
Tel: 01252 629836
FBQ Pg 5/6
Rehabilitation
Please realistically describe your expectations of behaviour therapy: ___________________________
__________________________________________________________________________________
__________________________________________________________________________________
How much time can each household member dedicate to addressing the issue? ___________________
__________________________________________________________________________________
Terms & Information
Behaviour diagnosis and treatments plans consider current scientific theory. The diagnosis and
treatment plan are discussed during the consultation once relevant information has been collected, and
a comprehensive report is then posted or emailed within approximately 8 days. A copy of the report is
also sent to the referring Veterinary Surgeon, with private or sensitive personal information excluded.
Pet behaviour therapy can be integral to identifying maintenance factors with problem behaviour and
devising strategies to extinguish or decrease this. However, in some cases maintenance factors may
not be identifiable and behaviour modification plans may not be effective. This scenario is unusual,
but those seeking pet behavioural therapy should be aware of this possibility. Behaviour modification
plans may produce desired results quickly, although it is generally the case that time, commitment and
consistency is required. This is because behaviour often develops over a significant time period and
equally it may take time to change this. Implementing the behaviour modification plan remains the
owner’s responsibility at all times. This is alongside responsibility for the pet’s welfare and behaviour.
Payment terms are as follows. The consultation fee includes a home visit (c.2.5 hrs), a comprehensive
report which is copied to the referring vet, a payment receipt, travel within a 10 mile radius and email
or telephone support for 12 weeks - up to a maximum of 4 hours time (this can be extended without
extra expense incurred, on a discretionary basis). In general, further appointments are not required, but
if requested these are charged at £40. Travel fees outside of a 10 mile radius of Fleet, Hampshire are
agreed at the time of the enquiry. Payment is due by cash, cheque or bank transfer at the time of
consultation. A charge (50% of the consultation fee) is incurred for cancellations within 14 days of the
scheduled consultation to compensate for preparation time and business loss.
Please sign or type your name and write/type the date to confirm that you have read and agree to the
terms detailed:
Signed: _________________________________
Date: ______________________
Please do contact me if your situation changes. I look forward to meeting with you and your cat.
Deborah Fry BSc (Hons) MSc www.animalbehaviourconsult.co.uk
[email protected]
Tel. 01252 629836
FBQ Pg 6/6
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