Behavioral History

The information you provide below will be used during your consultation to develop a diagnosis and plan of treatment. Please fill it out as completely as you can. All information will be held in strict confidence and will not be released to any third party without your written consent.

Please submit at least 2 business days prior to your cat’s appointment.

For this cat, please describe the daily routine:

***Please complete the remainder of this form if your cat is eliminating in areas other than the litter box. Otherwise, you have completed the history form and may send it to Dr. Sackman. Thank you! ***

Does your cat do any of the following?

Please answer the following regarding all litter boxes.