* 1. Your name:

* 2. Your cat's name:

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

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

* 5. Daytime phone number:

* 6. Evening phone number:

* 7. Email address:

* 8. Your veterinarian:

* 9. Your veterinarian's phone number:

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

* 11. Tell me more about your cat:

* 12. Where did you get your cat?

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

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

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

* 16. When did this behavior begin?

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

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

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

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

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

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

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

* 24. How do you play with your cat?

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

* 26. What training does your cat have?

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

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

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

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

* 31. Other information you would like to share:

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