Courteous Canine, Inc.

Name*

Email*

Address*

Phone*

Other Phone

How did you hear about us?*

Training Information

Location Preference*

In HomeVirtual

Preferred time of day and day of week for your training session, please check all that apply:*

During the day during the weekDuring the evening during the weekOn the weekend

Select your home type*

Other home type:

My experience with cats is:*

Cat breeds I have parented: *

How busy is your home: *

Very busy - visitors every dayModerately busy - visitors several times a weekMildly busy - visitors once a weekQuiet – very rarely have visitors

In addition to you, list the names and ages of all people and animals in the household, including yourself:*

Do any of these animals fight with each other? *

YesNoN/A

If yes, please elaborate:

Primary Cat Name:*

Date of Birth:*

Sex*

Spayed or Neutered *

YesNoUnknown

Breed*

Weight*

Is your cat microchipped?*

No/yes

Age when Spayed or Neutered?*

Pediatric6 months AdultUnknown

1. What is the main problem behavior or complaint?*

2. Are there other behavior problems? *

No/yes

If yes, please explain:

3. When did you first notice the problem?*

4. What general circumstances does the cat misbehave? What are the triggers?*

a. Stressb. Interhousehold conflict with another animalc. Interhousehold conflict with a persond. Environmental changes

Comment box to elaborate on your answer:

5. What should the goal of training be:*

6. Has this cat had previous training? *

No/yes

7. If yes, with whom and on what behaviors and explain methods used:

8. Is the problem behavior getting better, worse or staying the same?*

BetterWorseSameOther

Other (please explain):

9. What have you done to try to fix the problem?*

What is the possible outcome if this behavior is not resolved: *

11. Where did you get this cat?*

12. How old was the cat when you got him/her? *

13. Has this cat had other parents? *

YesNoUnkown

14. Rate your bond with this cat: (0 no bond up to 10 maximum bond)*

15. If the problem were resolved would the bond number go up? *

No/yes

16. What do you feed your cat?*

17. Is your cat’s food down all the time or do they eat on a schedule:*

Feeding ScheduleFood down all the time

18. Does your cat finish their meals within 10 minutes of when you feed them? *

No/yes

19. Does your cat ever miss meals?*

No/yes

20. Does your cat groom regularly? *

No/yes

21. What is your cat’s relationship to the other people and animals in the household (friendly, hostile, fearful)? Please describe.*

22. How is your cat when they are left alone? *

a. Parent absent vocalizations?b. Parent absent destructive behavior? c. Parent absent urination or defecation outside of litter box?

If box c is checked: Urine/feces/both?UrineFecesBoth

How many litter boxes?

How often are they cleaned?

Has the cat seen a vet about the litter box problem?

No/yes

23. How is your cat during thunderstorms or fireworks:*

No issuesMild noise issuesModerate noise issuesSevere noise issues

If noise issues, then how do they react?

24. Has your cat ever shown aggression toward you: *

No/yes

If yes, please explain:

25. Does your cat resource guard: *

Other (please explain):

26. How is your cat with strangers?*

Other (please explain):

27. How do you mentally stimulate your cat?*

28. How do you physically stimulate your cat?*

29. Length per day of mental stimulation (min per day or week): *

30. Length per day of physical stimulation (min per day or week): *

31. Does your cat have medical conditions: *

No/yes

If yes, please explain:

32. Please list any medication your cat takes: *

33. What do your cat’s stools look like: *

normal well-formedloose puddingloose like water

34. Where does your cat sleep:*

35. How many hours does your cat sleep:*

36. Does your cat wake you at night? *

No/yes

If yes, please explain:

37. How well does your cat relax in your home when there is no activity? *

Other (please explain):

38. If you use a groomer, please explain if there are problems with the groomer:

39. If you use boarding, please explain if there are problems with boarding:

40. If you use a pet sitter, please explain if there are problems:

41. How is your cat when you have guests:*

Other (please explain):

42. How is your cat with children:*

Other (please explain):

43. How is your cat at the vet:*

Other (please explain):

44. Does your cat have any problems being handled: *

No/yes

If yes, please explain:

45. What are your cats three favorite foods?*

Cat Behavior Consult Intake Form

Please enter all required fields above.