Indoor Cat Questionnaire

Study:

How many cats are in the household (please fill out this survey for each of them)?

What is your cat's name?

What is your cat's weight (in pounds):

Please choose a Body Condition Score (BCS) for your cat:

Diet:

If you have more than one cat, what is their relationship?

Where did you obtain your cat (source)?

What breed is your cat?

What sex is your cat?

Is your cat neutered?

Is your cat declawed?

How old is your cat?
(years) (months)

How long have you owned your cat?
(years) (months)

How many dogs live with your cat?

Which of the following best describes your home?

How many litter boxes do you have in the house?

If you have multiple litter boxes, are they in different rooms of the house?

If you live in a multi-level house, are the boxes located on more than one level?

Does the cat have its own litter box?

Are litter boxes located in a convenient, well-ventilated location that still gives the cat some privacy while using it?

Are litter boxes located so that the cat has easy access to and from the box?

Are litter boxes located away from appliances and air ducts that could come on unexpectedly?

Are litter boxes washed regularly?

Is unscented litter used?

Is clumping litter used?

Is the type of litter used kept consistent?

Is the litter scooped as soon after use as possible; at least daily?

Are bowls located such that another animal cannot sneak up on the cat while it eats?

Does the cat have its own food bowl?

Does the cat have its own water bowl?

Are the bowls located in a convenient location that provides some privacy while it eats or drinks?

Are bowls washed regularly (at least weekly) with a mild detergent?

Are bowls located away from appliances and air ducts that could come unexpectedly?

Does the cat have its own resting area in a convenient location that provides some privacy?

Does the cat have a safe hiding area?

Are perches provided so the cat can look down on its surroundings?

Can the cat move about freely, explore, climb, stretch and play if it chooses to?

Is a radio or TV left playing when the cat is home alone?

Does the cat have the opportunity to be petted?

Does the cat have daily play sessions where owners actively interact with it?

Does the cat have a variety of toys to play with?

Does the cat have many toys to choose from?

Does the cat like to play with toys?

Can the cat play with other animals or the owner if it chooses to?

Are horizontal scratching posts provided?

Are vertical scratching posts provided?

How many hours per day are you within sight of your cat?

How attached are you to your cat?

Has your cat been diagnosed with any of the following conditions?

Skin Disorder:
Kidney:
Ear:
Upper Gastrointestinal:
Eye:
Lower Gastrointestinal:
Lung/Upper Respiratory:
Urinary:
Endocrine:
Neurological:
Heart:
Teeth:

Liver:

Viral:

Have you seen your cat:

Scratch at its skin or lose hair abnormally?

Excessively scratch at its ears?

Produce hairballs or vomit?

Have diarrhea, constipation or strain to defecate?

Strain to urinate, attempt to urinate frequently, urinate outside its litter box or have bloody urine?

Cough, gag, sneeze or wheeze?

Have "runny" eyes?

Act aggressively?

Act fearfully?

Act nervous?

What is your cat's response to the telephone ringing?
(-3 being fearful, +3 being curious)

What is your cat's response to a knock at the door?
(-3 being fearful, +3 being curious)

We would also ask that you provide us with your contact information so that we may get in touch with you regarding future studies. This information will not be shared with any other group and any unrequested contact will be kept to an absolute minimum.

First Name:
Last Name:
Address:
City:
State/Province:
ZIP/Postal Code:
Country:
Email:

Do we have your permission to contact you for follow-up studies?