Behavior Questionnaire Owner Name Cat Name * Email * Phone General information Owner(s): Please list names, ages, sex, of all people in your household: * Please describe your house or apartment, number of rooms, etc. * How long at this address? * List any significant changes in the household including any change in number of household members or pets, construction within or outside home, new furniture, sources of stress for family members, etc. * Animals: List in order of obtaining them, all pets in your household. Include when obtained, age, sex, personality, medical history, anything you can think of that may explain interrelationships. * Describe in detail what, how often, and where you feed your pets. * Describe the litter box plan for your home: how many, where placed, type of box, type of litter. Describe in detail each behavior of each animal, that you consider a problem. What will you do if our plan to correct these behaviors fails? Please describe any methods used to correct the behaviors prior to filling out this questionnaire. Would you consider seeing a veterinary behaviorist for these problems? Are you willing to use medication to help change problem behaviors? Captcha If you are human, leave this field blank. If you have any questions regarding this questionnaire, please call the Cat Clinic of Plymouth at (508)746-8580.