Older Cat Behavior Changes

Animal Behavior Clinic, Box 25, College of Veterinary Medicine, Cornell University
Ithaca, NY 14853-6401
Dr. Katherine A. Houpt, Director 607-253-3450; Dr. Julia Albright 607-253-4350
Fax 607-253-3846
 http://www.vet.cornell.edu/abc
email: vabc@cornell.edu

Please answer the following questions and send this form (mail/fax/email) back to us. Please be sure to include a diagram of your house floor plan. On the diagram note food/water bowls, litter boxes, major appliances, and favorite resting locations of your cat(s). If your cat is inappropriately eliminating please mark all sites where your cat has soiled with an X. Specific questions about the problem behavior(s) will be asked during your appointment.

General Information
Client's name: _________________ Name of pet: _________________
Address: _________________ Breed: _________________
_________________ Date of Birth: _________________
  _________________ Age: _________________
Zip Code: _________________ Sex: _________________
Home phone: _________________ neutered/spayed: _________ Color:_________________
Work/Day phone: _________________ Who referred you to us? ______________________
Age at acquisition: _________________    

Who is your regular veterinarian:

Dr. _____________________________
Clinic Name: _____________________________
Address: _____________________________
_____________________________
Phone: _____________________________
Fax: _____________________________

Has your cat been previously diagnosed with any medical problems? Yes No What?

Is your cat currently on medications? Yes No What?

Is your cat currently on a prescription diet? Yes No

Does your cat have a food allergy? Yes No

 

 

 

Key: M1-Mild, M2-Moderate, M3-severe

No

M1

M2

M3

When began?

Weight gain ____ Weight loss ____

          

Appetite increase ____ decrease ___

          

Vomiting __

          

Diarrhea ___ Colitis (stool with mucous or blood) ___

          

Constipation/difficult defecation ___

          

Increased drinking___ Increased urine____

          

Coughing ___ Weakness after exercise ___ Panting____

          

Lumps/tumors ___ skin problems ___Describe:

          

Bad breath / sore gums / difficult chewing

          

Muscle tremors / shaking

          

Weakness / uncoordination

          

Difficulty climbing stairs / increased stiffness

          

Diminished vision

          

Diminished hearing

          

House soiling: Bowel movement ___

Urine: ___ Horizontal surface____ Vertical ____

         

Sleep/wake cycles: Wakes at night / restless sleep

          

Increased Anxiety ___ Fear ___

          

Increased Vocalizing

         

Aggressive when petted / handled

         

Decrease in play behavior / decreased interest in toys

         

Sleep: Increase ___ Decrease ____

          

Purring: Increase ____ Decrease ____

          

Attention seeking: Increased ___ Decreased ___

          

Greeting of family members and familiar people

Increased ___ Decreased ___

          

Interest in social contact / attention: Increased ___ Decreased ____

          

Activity level: Increased ___ Decreased ____

          

Disorientation / confusion:

Gets lost ____ goes to wrong side of door ____

Looks for food or water in wrong place ____

Gets lost in the house or yard ___

Can’t find his way out from under furniture / corners ___

         

Purposeless activity – Wanders / paces ___

         

Repetitive / compulsive Circling ___ Tail chasing ___

Licking ___ Sucking ___ Chewing ____

Self induced hair loss (licking, chewing) ____

          

Grooming: Increase ____ Decrease ____

          

Altered relationship with other pets ____