Your name:

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* 1. Your name:

Your cat's name:

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* 2. Your cat's name:

How were you referred to Animal Behavior Insights?

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* 3. How were you referred to Animal Behavior Insights?

Street address, City, State and Zip Code

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* 4. Street address, City, State and Zip Code

Daytime phone number:

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* 5. Daytime phone number:

Evening phone number:

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* 6. Evening phone number:

Email address:

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* 7. Email address:

Your veterinarian:

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* 8. Your veterinarian:

Your veterinarian's phone number:

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* 9. Your veterinarian's phone number:

What medical tests or exams have taken place since behavioral symptoms began?

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* 10. What medical tests or exams have taken place since behavioral symptoms began?

Tell me more about your cat:

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* 11. Tell me more about your cat:

Where did you get your cat?

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* 12. Where did you get your cat?

How long ago did they join your family?

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* 13. How long ago did they join your family?

What was your cat like as a kitten?

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* 14. What was your cat like as a kitten?

Describe the main behavioral problem you are seeking help with:

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* 15. Describe the main behavioral problem you are seeking help with:

When did this behavior begin?

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* 16. When did this behavior begin?

What have you tried to do to change this behavior problem so far?

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* 17. What have you tried to do to change this behavior problem so far?

What other behavioral problems does your cat display? (Check all that apply)

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* 18. What other behavioral problems does your cat display? (Check all that apply)

Please describe any behavioral problem that your cat is experiencing not listed above.

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* 19. Please describe any behavioral problem that your cat is experiencing not listed above.

For any behavior checked above, please describe any relevant details:

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* 20. For any behavior checked above, please describe any relevant details:

Has your cat bitten or scratched a person? If so, who and how badly? Please describe.

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* 21. Has your cat bitten or scratched a person? If so, who and how badly? Please describe.

Please list the human members of your family by name and age (if under 18).

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* 22. Please list the human members of your family by name and age (if under 18).

Please list the animal members of your home by name, age, sex and species/breed.

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* 23. Please list the animal members of your home by name, age, sex and species/breed.

How do you play with your cat?

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* 24. How do you play with your cat?

What does your cat eat? Please list type of food, amount and schedule.

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* 25. What does your cat eat? Please list type of food, amount and schedule.

What training does your cat have?

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* 26. What training does your cat have?

How many minutes per day are you able to spend working with your cat to improve their behavior?

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* 27. How many minutes per day are you able to spend working with your cat to improve their behavior?

What time works best in your schedule for a consultation? You will be contacted with available openings that fit your schedule.

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* 28. What time works best in your schedule for a consultation? You will be contacted with available openings that fit your schedule.

What kind of consultation are you looking for?

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* 29. What kind of consultation are you looking for?

How serious a problem is this behavior for you and your family?

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* 30. How serious a problem is this behavior for you and your family?

Other information you would like to share:

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* 31. Other information you would like to share:

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