Behavior Questionnaire General InformationYour Name* Pet's Name* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home/Cell Phone*Work PhoneBreed* Pet's Date of Birth* MM slash DD slash YYYY Pet's Age* Sex* Female Male Neutered/Spayed?* Yes No Behavior ProblemWhat is your main behavior problem or complaint?When did this problem start?Do you recall anything specific at the onset of the behavior problem? (i.e. moving, birth of a child, houseguests, construction, parties, etc.)How frequently does the problem (or problems) occur?Has the problem changed in frequency or intensity? Elimination BehaviorHow many litter boxes do you have?Describe your cat’s litterbox and the number of litterboxes in the facility.Where do they eliminate that is NOT in their litterbox?Where are the litter boxes?Does your cat dig in the litter before eliminating?Does your cat cover urine and feces in the litter box? Home Environment/Social BehaviorList all family members including people, cats and dogs, as well as any other non-caged animal in the home.CAPTCHA
