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FELINE Intake Form
Hello and welcome to our intake form for cat consults. Please read each question carefully and answer to your best ability. If you have any questions, we can be reached at get@apleasantdog.com or 616-264-2532 during regular business hours. Thank you for trusting us with your feline friend! 
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Email *
First and Last Name  *
Phone Number *
Home Address *
Who referred you to A Pleasant Dog?
I understand that working with live animals may entail certain risks of personal injury to myself or my animal(s). I hereby acknowledge my voluntary and informed assumption of full responsibility and liability regarding any injuries that I or my animals may incur coincident to my participation with A Pleasant Dog. I hereby assume any and all risks associated therewith and expressly waive, release, discharge and hold harmless A Pleasant Dog, its members, agents, employees and assigns from and against any and all liability for loss, damage, injury, illness or claim of any nature whatsoever, however caused, arising out of, in association with, or related in any way to my involvement with its services. *
Required
What vet clinic do you go to?  *
Cat's Name  *
What breed is your cat? *
What color is your cat? *
Cat's Sex: *
Birthdate *
Are they spayed/neutered? *
Where and when did you get your cat from? *
Is your cat:  *
Is your cat declawed?  *
If your cat is declawed: how old were they at the time of the surgery? *
What goals or behavior concerns do you want help addressing? *
When did these behavior concerns start?  *
How serious do you feel these behavior concerns are? *
How do you typically deal with these behaviors?  *
How does your cat react when you come home? *
How does your cat react when other people come into your home?
Do you have any other pets in your household? Any pets that frequently visit? *
How does your cat interact with the other pets?  *
Do the other pets have any behavior concerns? *
Any other interactions with animals either wild or domestic? *
How does your cat react when seeing or going into a cat carrier? *
Does your cat have any history of trauma (being attacked, fires, floods)? *
How many litter boxes do you have? *
How often do you scoop the litter box? *
How often do you fully dump out the soiled litter and replace with fresh litter? *
Does your cat have any other fears or noise sensitivities? If yes: please describe *
Has your cat ever urinated or defecated outside of the litter box? If yes: please describe *
How does your cat react when being pet? *
Is this your first time with formal behavior consultation for your cat? *
Have you ever used correction with your cat to stop a behavior? (Yelling, scaring them with a noise, hitting them, etc. This is a no judgement zone! We ask so we can help!) *
Have you had any changes to your household in the last year, such as new people moving in, people moving out, moving homes, new animals, remodeling, etc?  *
If yes, please describe:
How does your cat react at veterinary visits?
Have you consulted with a veterinarian to rule out medical causes for the behavioral concerns? 
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If yes, briefly describe veterinary findings: 
Please list your cat's current medications and recent surgeries (if applicable): 
How many scratching surfaces do you have for your cat? What type of material are they? 
Where does your cat eat?  How often?  *
What food type do you feed your cat?  *
Required
How often do you engage in play with your cat? What types of play or toys does your cat prefer?  *
The information you have provided will be used during your consultation will be used to develop a diagnosis and training/management plan. All information will be held in confidence but will be shared with your veterinarian and their team.
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