Intake Cat History Questionnaire

Email for non-humans

Cat Name *

Age *

Sex *

Spayed/Neutered *

Breed *

Colour *

In heat/Pregnant/Nursing

ID (Tattoo/Microchip)

Declawed *

Health Information

Does your cat have any past or present medical conditions *

If yes, what are they *

Current medications (please specify)

Current diet (please specify)

Do you give us permission to get your files from your vet

If yes, which veterinarian clinic do you use *

Reason For Surrender

Behaviour issue (please specify) *

Other (please specify) *

History

How long have you owned your cat *

Has your cat had other owners *

If yes, do you know if this cat was previously kept indoors or outdoors

Do you let your cat outdoors

Is your family *

Quiet live alone
Retired couple
Active family
Quiet family
Someone always home
No one home during day
Children
Other

Is your family Other *

Is your cat *

Age of any children in house

Is your cat comfortable with

Women
Men
Children
Seniors
Loves all People

Does your cat get along with

All animals
Only cats
Male cats
Female cats
Only dogs
Does not get along with other animals

If does not get along with other animals, please explain (i.e. aggressive towards other animals, or ignores other animals) *

Has your cat lived with other animals *

Cats
Dogs
Other animals

Number of cats and gender *

Length of time cats were living together *

Number of dogs and gender *

Length of time cat and dogs were living together *

Other Animals *

Diet

What do you feed your cat *

Brand of food *

Number of times per day your cat is fed

What is the status of your cat’s appetite

Favourite treats

Food to avoid

Scratching

Does your cat scratch

Scratching posts
Soft furnishings (sofa, drapes, etc.)
Carpets/rugs
Wood furniture (cabinet doors, etc.)
Nothing
Other

Other

Behaviour & Play

Does your cat *

Jump on counters/tables
Beg for food
Eat plants
Chew personal items
Climb curtains
Play gently, does not usually use teeth or claws
Like to play rough, may bite or scratch
Like to chase & pounce with variety of toys
Like things that crackle, such as paper bags
Like to play hide & seek
Will fetch items like bottle caps or toys
Chase bugs or moths
Like to play in or around water
Like to learn tricks for treats
Like to play with other cats
Like to play with dogs
Not interested in play
Other

Other *

Please check all that apply

My Cat is Vocal

With Me *

With Other Cats in The Home *

By Themself *

My Cat is Fearful

With Me *

When at the Vet *

Towards Vistors *

With Children *

With Loud Noises (ex. Vacuuming) *

Of Other Cats *

Of Dogs *

My Cat is Friendly

With Me *

With Strangers *

With Other Cats *

With Children *

With Dogs *

Other Information

Likes to Sleep in Bed with me *

Likes to be Pet *

Wants to be Where I am *

Is Active *

Is Easy Going *

Likes to be Brushed *

When I Pet My Cat *

When I Pick Them Up *

Towards Other Cats *

Towards Dogs *

Please feel free to tell us any additional helpful information (favourite toys/ games/treats, bad habits, etc.)

Litter Box Habits

Does your cat have access to a litter box in the house *

What type(s) of litter was used *

Unscented
Scented
Clumping
Non-Clumping
Crystals
Clay
Pine
Yesterday’s News
Other

Other *

How many litter boxes are in the home *

Location of the litter box(es) *

What types of litter boxes *

Covered
Open
Other

Other *

If there are other cats in the home, how many shared a litter box *

Is your cat *

Has your cat ever failed to use the litter box *

When did you notice that your cat failed to use the litter box (approximate date) *

Did you change the brand or type of litter in the last few months *

Please describe the accidents *

Other *

If your cat has failed to use the litter box, what was the frequency *

Was it always at a specific time of the day or night *

Is there an identifiable event that influenced or triggered inappropriate litter box use? (new baby, moving, schedule changes, renovations, etc.) *

What steps were you able to take to try and correct the problem *

Were these steps successful in correcting the problem *

Was your veterinarian able to rule out the possibility of a bladder infection, urinary crystals, or other medical issues *

Your Name *

Your Phone Number

Your Email *

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