PIT Animal Questionnaire: Cats and small animals

PIT Program: Cat #1

Cat's name *

Breed (e.g., Domestic shorthair (DSH), Siamese) *

Age *

Gender *

Male

Female

Is this cat spayed or neutered? *

Yes

No

Unsure

Does this cat have a microchip? *

Yes

No

Unsure

Is this cat declawed? *

Yes

No

Unsure

How long have you had this cat? *

What brand/type of food does your cat eat? How much food do you feed them a day?

What medical care does this cat require (e.g., medication)? *

Has this cat ever bitten/scratched a person or animal? If yes, please explain the situation(s) and details of the wound(s): *

Has this cat ever lived with another cat? *

Yes

No

Unsure

How does this cat interact with cats?

a) Plays with and rests beside other cats

b) Doesn't interact much; not social or aggressive with other cats

c) Hides from other cats and avoids them

d) Swats or fights with other cats

f) I have not seen this cat around another cat

g) Otherg) Other

Has this cat ever lived with a dog? *

Yes

No

Unsure

How does this cat interact with dogs?

a) Rubs up against dog, doesn't shy away

b) Keeps distance from dog but won't run away if dog approaches

c) Runs if dog approaches, hides when dog is around

e) I have not seen this cat around a dog

f) Otherf) Other

Has this cat ever lived with children? If yes, please list the children's ages: *

How does this cat interact with children?

a) Seeks out children for attention, chooses to be around children

b) Doesn't actively seek out children for attention but doesn't hide from them

c) Hides when children are around

d) I have not seen this cat around children

e) Othere) Other

Does this cat have any behavior concerns? If yes, please provide more details::

Share any additional information you'd like here:

PIT Program - Cat #2

Cat's name *

Breed (e.g., Domestic shorthair (DSH), Siamese) *

Age *

Gender *

Male

Female

Is this cat spayed or neutered? *

Yes

No

Unsure

Does this cat have a microchip? *

Yes

No

Unsure

Is this cat declawed? *

Yes

No

Unsure

How long have you had this cat? *

What brand/type of food does your cat eat? How much food do you feed them a day?

What medical care does this cat require (e.g., medication)? *

Has this cat ever bitten/scratched a person or animal? If yes, please explain the situation(s) and details of the wound(s): *

Has this cat ever lived with another cat? *

Yes

No

Unsure

How does this cat interact with cats?

a) Plays with and rests beside other cats

b) Doesn't interact much; not social or aggressive with other cats

c) Hides from other cats and avoids them

d) Swats or fights with other cats

f) I have not seen this cat around another cat

g) Otherg) Other

Has this cat ever lived with a dog? *

Yes

No

Unsure

How does this cat interact with dogs?

a) Rubs up against dog, doesn't shy away

b) Keeps distance from dog but won't run away if dog approaches

c) Runs if dog approaches, hides when dog is around

e) I have not seen this cat around a dog

f) Otherf) Other

Has this cat ever lived with children? If yes, please list the children's ages: *

How does this cat interact with children?

a) Seeks out children for attention, chooses to be around children

b) Doesn't actively seek out children for attention but doesn't hide from them

c) Hides when children are around

d) I have not seen this cat around children

e) Othere) Other

Does this cat have any behavior concerns? If yes, please provide more details:

Share any additional information you'd like here:

SECTION 3 - Small animal #1

Animal's name

Species (e.g. Rabbit, Guinea pig, Budgie)

Age

Gender

Male

Female

Unsure

Is this animal spayed or neutered?

Yes

No

Unsure

How long have you had this animal?

What brand/type of food does your small animal eat? How much food do you feed them a day?

What medical care does this animal require (e.g., medication)?

Has this animal ever bitten/scratched a person or animal? If yes, please explain the situation(s) and details of the wound(s):

Please describe this animal's housing/cage set up:

Does this animal get "out-of-cage" time? If yes, how often and for how long, approximately?

Has this animal ever lived with children? If yes, please list the children's ages:

Please describe this animal's comfort being handled (e.g., approaches people for interaction vs. tries to get away from people):

Share any additional information you'd like here:

SECTION 3 - Small animal #2

Animal's name

Species (e.g. Rabbit, Guinea pig, Budgie)

Age

Gender

Male

Female

Unsure

Is this animal spayed or neutered?

Yes

No

Unsure

How long have you had this animal?

What brand/type of food does your small animal eat? How much food do you feed them a day?

What medical care does this animal require (e.g., medication)?

Has this animal ever bitten/scratched a person or animal? If yes, please explain the situation(s) and details of the wound(s):

Please describe this animal's housing/cage set up:

Does this animal get "out-of-cage" time? If yes, how often and for how long, approximately?

Has this animal ever lived with children? If yes, please list the children's ages:

Please describe this animal's comfort being handled (e.g., approaches people for interaction vs. tries to get away from people):

Share any additional information you'd like here:

SECTION 3 - Small animal #3

Animal's name

Species (e.g. Rabbit, Guinea pig, Budgie)

Age

Gender

Male

Female

Unsure

Is this animal spayed or neutered?

Yes

No

Unsure

How long have you had this animal?

What brand/type of food does your small animal eat? How much food do you feed them a day?

What medical care does this animal require (e.g., medication)?

Has this animal ever bitten/scratched a person or animal? If yes, please explain the situation(s) and details of the wound(s):

Please describe this animal's housing/cage set up:

Does this animal get "out-of-cage" time? If yes, how often and for how long, approximately?

Has this animal ever lived with children? If yes, please list the children's ages:

Please describe this animal's comfort being handled (e.g., approaches people for interaction vs. tries to get away from people):

Share any additional information you'd like here:

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