Behaviour Consultation Questionnaire

Please fill in the form to the best of your ability. If you have answered something previously or are unable to answer simply type N/A (Not Applicable). Thanks.

Questionnaire
For full package details and more information visit my behaviour consultation page.

Please fill in the pre-consultation enquiry form before continuing. If you already have my approval for this package please continue filling in this questionnaire.

Owner Details

This is important, so I can get back to you. Please make sure this is correct. Thanks.

Patient Details

Optional
e.g. trying to make a bed, producing milk, carrying a toy around with them, etc.
If known.

Early History

e.g. breeder/rescue centre/stray etc
e.g. hand-reared?
(e.g. Friendly, unfriendly, timid, confident).

Diet

e.g. brand names, wet/dry, etc.
e.g. how many feeds per day.
e.g. types of feeder, hand-feeding etc.
e.g. plastic, glass, ceramic etc
e.g. 2 in 1 plastic bowl, single ceramic, etc
and do they play with them?
e.g. diarrhoea, colitis, gastritis, vomiting etc.

Environment

Describe any problems with this
e.g. re-decorating, change of cage, etc.
Please include the room, as well as the actual position of the cage.

Play

Please describe

Environment

e.g. cat towers, shelves, etc

Exercise

(e.g. flexi-lead, collar, harness, head-collar etc.)
e.g. Not well socialised, can be aggressive, fearful of other dogs, runs away, etc

General Behaviour

Does your bird demonstrate any of the following behaviours and under what circumstances:

Select all that apply

Toileting

Housing

Training

e.g. Sit, Stay/Wait, Watch, This Way/Come, Give, etc

Family Members

e.g. birth of a child, house move, change of job etc.

If you have other cats in the household there will be an opportunity to answer questions about their relationship in more detail later in the questionnaire.

Human Interaction

Other Cats in the House

If this is the main problematic behaviour and reason for reaching out to me, you may wish to describe the issue more fully in ‘The Problem’ section later.

The Problem

Please answer all the following questions to the best of your ability. Please put N/A if you've answered these earlier.

There will be other questions specific to the problem later on, but if you think you've answered them here please indicate by answering N/A.
If so, what methods were used?
Select any that apply.

Other Problems

Your Cat’s Living Space

If possible please draw a basic house floor plan on a piece of paper or by drawing using software on your computer and upload it below. Don’t worry – this doesn’t have to be to scale. Mark all items listed below on the plan so I can get a feeling for their environment.

If you have real difficulties drawing a plan or unable to upload, don’t worry as we can do a virtual tour using your device if we have a Zoom consultation or you can record a video and send it to me.

Please include: 

a = Litter box locations
b = House-soiling locations*
c = Windows and doors
d = Scratching post locations
e = Food and water bowl locations
f = Cat doors or flaps

*If your cat house soils indicate the areas they soil.

Accepts images (jpg, jpeg, gif, png, bmp), documents (doc, docx, odt, odf, pdf, rtf, txt) and videos (avi, mov, mkv, mp4, m4v, mpg, mpeg).
e.g. whining, barking, distress, etc

Finally

Select any that apply and provide any additional comments if necessary.
I only require brief information as your vet should pass on details with the referral form.
Wherever possible I will try and accommodate your preferences.
Thank you for taking the time to complete the questionnaire. If you cannot answer all the questions please do not worry as we can discuss them in detail during your consultation.