Skip To Content

Feline Initial Behavior Appointment

Basic Information

Patient's Information
Owner Information
Co-Owner Information
Primary Veterinarian Address

Household Information

Other Pets in Household (In order of when they came into household)
Type of House
Neighborhood

List any major household changes since acquiring this cat (ie moves, illness/death of pets/people, added new people/pets to household etc.)

Acquisition Information
Where did you obtain this cat?
Why did you acquire this cat (check all that apply)?
Neutering Information
Is this cat neutered/ spayed?
Reason for neutering/ spaying?
Did you notice any changes after neutering/spaying?
If not neutered/spayed, reasons for not neutering/spaying:
Medical History
Please list all medications/ treatments your cat is CURRENTLY receiving, including heartworm, flea/ tick preventative/ collars, dietary supplements, herbal/homeopathic treatments:
Daily Activities/ Routine
Meals/ Types of Food
Do you use a slow feeder or food dispensing device?
Does your cat have food available all day?
Eating Habits (Check all that apply)
Does your cat go outside?
If yes...
Play
Does your cat play with toys?
How often does your cat play with toys?
How often does your cat play with people?
How often does your cat play with other animals?
Litterboxes
Please fill out the following for each litterbox in your household:
Please list any additives or cleaning products used.
Do you have a second litter box?
Please list any additives or cleaning products used.
Do you have a third litter box?
Please list any additives or cleaning products used.
Do you have a fourth litter box?
Please list any additives or cleaning products used.
Do you have a fifth litter box?
Please list any additives or cleaning products used.
Does your cat engage in any of the following behaviors at least once weekly:
Housesoiling
Excessive vocalizations
Destructive scratching
Self licking/chewing
Pacing/ repetitive behavior
Consumes non-food objects
Circles/ chases tail/ freezes
How does your cat react to the following:
Unfamiliar people at door
Unfamiliar people in home
Babies
Children
Other cats in household
Other cats (does not live with)
Dogs in household
Other dogs (does not live with)
Squirrels/ birds/ etc.
Carrier
Car rides
Veterinarian's Office
Being left alone
Thunder
Loud noises
Petting (by familiar people)
Primary Behavior Problem
Please fill out this section IN DETAIL. The more thorough you are with this form the more time it will allow during the appointment to discuss treatments instead of going over your cat's history:
Frequency of Primary Behavior Problem:
Is the frequency...
What percent of the time that your cat is in a potentially problematic situation does the problem behavior occur?
Has anyone suggested that you euthanize or rehome this cat because of this problem (this is not a recommendation; we just want to know what has been suggested)?
Have you ever considered euthanasia or rehoming your cat because of this problem?
Do we have permission to post pictures on our social media?

As the representing owner, agent or handler dealing with the individuals who will be working with the pet(s) indicated above, I understand that behavior therapies recommended by Dr. Laurie Bergman may involve some level of risk to the pet(s) and or the handlers, or other people or property in spite of our best efforts to minimize them. I will use my own judgement and common sense when following any recommendations so as not to place people, pets and property at undue risk.

Furthermore, I realize that the clinicians, Hickory Veterinary Hospital and its agents/ employees cannot guarantee that a pet will not be aggressive or cause injury to people or property in the future and I acknowledge that the pet's owner(s) and handler(s) continue to be solely responsible and assume all liability for any future aggression or misbehavior.

By typing my name below, I am freely assuming these risks and shall not hold Hickory Veterinary Hospital or its clinicians, agents, employees or facility owners liable for any loss or injury which may occur to handlers, pet, or other people, other animals or property while using their training and medication treatment recommendations, and I hereby waive any claim for damages arising out of such matters and agree to hold Hickory Veterinary Hospital and its clinicians/ agents/ employees harmless from any such claims.

*** Behavior initial consults are $467 and a 50% deposit is required to schedule.

Back To Top