Feline Case History Questionnaire by fDQ7Zq

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									                          Case History Questionnaire
Date of consultation:                                        Case Number:


                        Feline Behaviour Therapy
                    Ellena Hinson BSc (Hons) PGCE PG Dip CABC
                                  07400 967307

Please answer the following questions accurately and in as much detail as
possible.

Background information

Your name:

Address:



Daytime Tel No:

Evening Tel No:

Email address:

Referral Vet Surgeon:

Address:



Name of cat:


Breed/Type:                        Age:               Sex:


Is your cat neutered?


Early history

   How old was your cat when you obtained him/her?


   Can you remember where he/she came from? How much do you know about
    his/her history?




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                       Case History Questionnaire

Family members

   How many people are there in your household? Are there any children? If so,
    how many and how old are they?


   Does everybody interact with the cat? Does the cat have a favourite person
    or people?


   How many other cats are there in the household? (For each one, please
    include their type, age, sex and personalities – i.e. are they bold, shy,
    independent, playful - in turn).


   For the other cats, please include when and where you obtained them.


   Do you have any other animals? (If yes, please include their type, age, sex and
    personalities – i.e. are they bold, shy, independent, playful - in turn).


   For these other animals, please include when (approx.) and where you
    obtained them.


   How does your cat/s get on with your other pets? (If there are many, please
    state who gets on best with who, i.e. does one cat share resting areas with
    one particular other cat or other animal?).


   Is there someone at home with the cat/s during the day?


Diet

   What do you feed your cat?


   How many times is he/she fed per day?


   Where does your cat eat?


   Where does your cat drink?




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                        Case History Questionnaire

   Do you give any supplements? If so, which ones?


   Does he/she enjoy their good or would you say they are fussy?


   Do you give any tit-bits? If so, what?


Medical history

   Is your cat suffering from any illness, disability or disease?


   When did the problem start?


   Is he/she on any current medication? If so, please state what it is.


   Do you know of any previous medical problems? If so, please state dates,
    period of illness/disease and any treatment/s.


Environment

   Does your cat have access to all areas of the house?


   Where does he or she sleep at night and during the day? Is this alone, or in
    company? If so, who with?


   Does your cat have a scratching post? If so, where is it, and does he/she use
    it?


   Does he/she scratch outside? What about inside?


   Have the dynamics changed in the household recently, i.e. has 1 pet passed
    away, or has someone in the family moved away? If so, please state when this
    happened.


   Does your cat/s have access to outdoors?




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                       Case History Questionnaire

   How does your cat/s gain access outdoors? (If by cat flap – is this manual,
    magnetic or microchip?) If manual, do you control this access at any time?


   Do you know whether there are any new cats to the area? If so, have you
    seen them around your house? If so, where?


   Does he or she tend to go out for long periods of time? For how long
    approximately?


   Does he/she go far? For example, does he/she tend to stay in the front
    garden, or go further afield?


Toileting

   Does your cat use a litter tray indoors? If so, what kind of litter do you use?


   How many litter trays do you have? Where are they positioned?


   What type (i.e.wood pellets) and brand of litter (i.e. Catsan) do you use?


   Do you see your cat urinating or passing faeces in the garden and/or outside?


   Has the cat ever done this inside other than in the litter tray? If so, where?


   Have you ever seen your cat spraying indoors or outside? If so, where?


   How often do you clean each litter tray?


   Does the cat spend a lot of time in the tray (i.e. scraping and digging?)


   Does your cat cry before using the litter?


   How often is each tray used (urine and faeces)?




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                       Case History Questionnaire

Soiling Problems

   Where exactly is the cat soiling?


   Is your cat urinating, defecating or both?


   Does your cat continue to eliminate outdoors intermittently?


   Has your cat been involved in any disputes outdoors or indoors with
    neighbourhood cats?


   Does your cat have a history of cystitis or urinary tract problems? If so,
    please give details and dates.


   How are you cleaning the soiled areas?


   Are you punishing the cat in any way? Please give details.


   Are you using deterrents? I.e. plastic sheets?


Human interaction

   Does your cat have any toys?


   Do you play with your cat? If so, for how long each day approximately? What
    games do you play?


   Does your cat tend to follow you about the house when you are at home? Is
    this at a particular time?


   Does your cat sit on your lap? Does he/she sit on everyone’s lap equally?


   Do you stroke your cat when he/she is on your lap? Do you ever have any
    problems doing this?




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                      Case History Questionnaire

   Does your cat ever suck or chew on your clothes? If so, what type of material
    is preferred, and when does it happen?


   Does he or she ever suck or chew on anything else? If so, what and when?


Other cats

   Are there other cats in the neighbourhood? For example, do your neighbours
    have cats?


   Do other cats come into your garden?


   Do they, or have they ever, come into your house?


                          Please go to the next page.




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                       Case History Questionnaire

                               Your Cats Territory

Floor Plan

Please use the next two pages to draw a plan of your cat’s territory. If you have
an indoor cat, draw a plan of the house, and if an outdoor cat include the garden
and/or surrounding area. As cats are territorial animals, such plans are very
useful in making an accurate diagnosis of your pet’s problem.

Please include, if possible: where the doors are, cat flaps, feed bowls, sleeping
places and litter trays. The site of inappropriate toileting, spraying, scratching or
chewing (you may want to use a key if you are including more than one problem
behaviour). Please also include your property boundaries, including what lays
on the other side, such as other cats, dogs, children, main roads.




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      Case History Questionnaire




Please continue on a separate sheet if necessary.




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                      Case History Questionnaire

The problem behaviour

   Describe the problems you are having with your cat in as much detail as
    possible (please use more pages if necessary).




   What happens immediately before your cat displays these behaviours? Try
    to think both what you and your cat is doing when the problem occurs.




   What happens immediately after? What do you do and what does the cat do?




   When did the problem begin? Can you remember the first time it happened?




   Can you remember anything else that was happening at this time? For
    example, moving house?




   When does the problem occur? Is it in any particular circumstances?




   Is there anything else distinctive that happens at the time of the problem
    behaviour?




   How frequently, on average, does the problem occur? Do you think it is
    becoming more frequent, less frequent or staying about the same?




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                        Case History Questionnaire

   Where does it occur? Is it, for example, always in the same place?




   Who is usually present at the time, if anybody?




   When was the last incident, and can you describe this?




   Have there been previous attempts to cure this problem? (If so, please
    describe, including when and what happened)


Other problems

   Does your cat have any other problems? For example, is he or she nervous of:

       -   Children?


       -   Strangers?


       -   Any family members?


       -   Dogs?


       -   Loud noises? If so, any noises in particular (i.e. thunder)?

   Is your cat good to:

       -   Groom?


       -   Stroke?


       -   Pick up?




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                      Case History Questionnaire

   Are there any other problems with your cat that you would like to discuss at
    the consultation?



Rehabilitation

   How much time do you feel able to commit to working with your cat to solve
    these problems?



   What would you envisage happening if the behaviour problem persists?




Thank you for your co-operation in filling in this questionnaire. If you have
   any queries please do not hesitate to contact me on 07400 967307.




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