(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 info@animalbehaviourconsult.co.uk, 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 info@animalbehaviourconsult.co.uk 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 info@animalbehaviourconsult.co.uk 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 info@animalbehaviourconsult.co.uk 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 info@animalbehaviourconsult.co.uk 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 info@animalbehaviourconsult.co.uk 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 info@animalbehaviourconsult.co.uk Tel. 01252 629836 FBQ Pg 6/6