Cat Behaviour Private Consultation Form Section One: Owner InformationName First Last Address Street Address City ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home NumberCellular NumberEmail Please list the names of others in your household, age and relationship to youAre you 18 or older? Yes No Section Two: Cat's InformationCats Name Cats Breed Cats Age Male or Female Is your cat spayed/neutered? Yes No If yes, which one? Spayed Neutered Is it declawed? Where did you get your cat? When did you get your cat? How old were they when you got them? Where is your cat kept when you are not at home? Where is the litterbox located? How many litterboxes are in the home? Untitled Is your cat free-fed or is there a schedule? Is your cat allowed outdoors? (please indicate on a leash, in the yard, under supervision, roams freely etc) Is your cat allowed on the couch/bed/counters etc.? Does your cat have access to other high places to climb/perch or relax on? When was the last time your cat visited a veterinarian? What was the reason for your visit? Tell us about the other animals in the household:Describe the relationship your cat has with other animals:Describe a typical day for your cat:Which if these best describes your cat? Agreeable Social Friendly High Energy Impulsive Curious Skittish Anxious Shy Extroverted Gets board easily Other Please describe your standard playtime with your cat, if any:What kind of toys does your cat play with? Does your cat have access to the same toys all the time? What behavioural issues are you experiencing? Inappropriate elimination (urine) Inappropriate elimination (feces) Inappropriate elimination (both) Aggressions/conflicts between cats Aggression towards humans Nighttime activity Training a kitten Chewing objects/wires Runaway Excessive licking (alopecia) Fear Other For any behaviour concerns, please describe what kind of training, punishment or management methods you've used so far.When did you first notice this behaviour? How would you rate the severity of the problem? Anything else you'd like us to knowPlease explain what you would like to learn through your cat consultationHow did you hear about our service? What is your preferred delivery method for the consult (zoom, phone, email)?