ICI Survey

Participation

What brings you to the Indoor Cat Initiative today?

If you're participating in a study, which study?

Cat Information

What is your cat's name?: *

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

Is your cat healthy?: *

Yes

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

Diet(wet):

Diet(dry):

How many hours each day, on average, does your cat spend indoors?

How many cats are in the household?: *

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

Where did you obtain your cat (source)?

Other Source:

What breed is your cat?

What sex is your cat?: *

Male

Female

Has your cat been neutered?: *

Yes

Has your cat been 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?

Litter Information

How many litter boxes do you have in the house?

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

Yes

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

Yes

Does the cat have its own litter box?

Yes

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

Yes

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

Yes

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

Yes

Are litter boxes washed regularly?

Yes

What type of litter is used? (If you're not sure, check the back of your litter container.):

What is the consistancy of the litter? (If you're not sure, check the back of your litter container.):

Is the type of litter used kept consistent?

Yes

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

Yes

Cat Food / Water

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

Yes

Does the cat have its own food?: *

Yes

Does the cat have its own water bowl?: *

Yes

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

Yes

Are bowls washed regularly, at least weekly?: *

Yes

Are bowls located away from applicances and air ducts that could come on unexpectedly?: *

Yes

Environment

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

Yes

Does the cat have a safe hiding area?: *

Yes

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

Yes

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

Yes

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

Yes

Does the cat have the opportunity to be petted?: *

Yes

Does the cat have have daily play sessions when owners actively interact with it?: *

Yes

Does the cat like to play with toys?: *

Yes

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

Yes

Does the cat have many toys to choose from?: *

Yes

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

Yes

Are horizontal scratching posts provided?: *

Yes

Are vertical scratching posts provided?: *

Yes

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

How attached are you to your cat?

Describe your cat's coat quality.

Describe your cat's grooming behavior.

Health

Please list any medications your cat is currently taking:

behavior

Have you ever 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? (growls, hisses or threatens when approached)
Act fearfully? (flees or hides when most cats would not)
Act nervous? (easily excited or irritated, jumpy, or timid)

What is your cat's response to the telephone ringing?

What is your cat's response to a knock at the door?

During the past 12 months, my cat has experienced	Estimated Date (Format: mm/dd/yyyy)	Effect on Cat's Disease Symptoms
Death or departure of a pet family member		Worse Same Better
Death or departure of a human family member		Worse Same Better
Serious hassle in the household (injury, illness, other)		Worse Same Better
New human in the household (spouse, baby, friend, child, other relative)		Worse Same Better
New pet(s) in the household		Worse Same Better
Change in schedule (work, school, travel, vacation, retirement)		Worse Same Better
Visitors (friends, relatives, etc.)		Worse Same Better
Construction around the house (inside or outside)		Worse Same Better
Changes of season		Worse Same Better
Weather changes (severe storms, earthquakes, etc.)		Worse Same Better
New house/apartment		Worse Same Better
Frequent loud noises (house/car alarms, neighbors, etc.)		Worse Same Better
Boarding		Worse Same Better
Remodeling		Worse Same Better
Moving/rearranging furniture		Worse Same Better
Neighborhood cats outdoors		Worse Same Better
Exam time (for students)		Worse Same Better
Holidays		Worse Same Better
Changes in diet		Worse Same Better
Change in litter		Worse Same Better
Travel (car, train, plane)		Worse Same Better
Other (please describe):		Worse Same Better

How difficult has this problem been for you and your family to deal with?

Veterinarian Information

Your veterinarian's name:

Your veterinarian's street address:

Your veterinarian's city:

Your veterinarian's state:

Your veterinarian's zip:

Your veterinarian's phone:

Contact Information

Owner's first name: *

Owner's last name: *

Address: *

City: *

State/Province: *

U.S. zip code:

Country: *

E-Mail: *

Please contact me for follow-up studies

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ICI Survey