• Feline History Form & Consultation Booking

    Pease allow 30-60 minutes to complete this form. A copy of your responses will be emailed to you once submitted.

  • Thank you for taking the time to fill out this history form - it provides vital information Dr. Squair needs to assess and plan treatment for your pet ahead of your appointment. 

    Because this is a longer form, we highly recommend saving your progress as you go so nothing is lost if you need to step away. Saving requires a free Jotform account, but no subscription is needed.

    Once submitted, you will move on to a deposit to confirm your booking, followed by scheduling your appointment time online. We recommend all primary caregivers attend, so it may help to check everyone’s availability ahead of time. After that, we will email you short consent and practice policy forms to review and sign.

    If you run into any issues or have questions along the way, email us at hello@prairiecrocusbehaviour.com - we're happy to help.

     

  • Pet Parent Information

  • Today's Date
     - -
    2 digit day, 2 digit month, 4 digit year
  • Please share how your learned about us*
  • Where are you located, and what type of appointment are you wanting to schedule?*

  • ADDITIONAL INFORMATION 

    *All feline appointments include a telemedicine consultation, where we go over your cat’s history and behaviour via Zoom. This is so your cat doesn’t have to spend 1–1.5 hours in the clinic, which can be very stressful for cats. The appointment also includes a brief 15-minute in-clinic assessment so Dr. Squair can see your cat in person and establish care. Telemedicine-only appointments are available only when an in-clinic visit isn’t possible (see below).

    **Telemedicine-only appointments are for Manitoba clients who find it difficult to travel to Winnipeg, or who have other circumstances that prevent an in-clinic visit. If you’re not sure which appointment type fits, please email us at hello@prairiecrocusbehaviour.com.

  • Format: (000) 000-0000.
  • Owner's Date of Birth*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Please share your preferred pronoun(s)
  • Does your pet have more than one owner?*
  • Format: (000) 000-0000.
  • Please share your preferred pronoun(s)

  • Pet Information

  • Is this appointment for more than one cat in your household (for example, conflict between your cats)?*

  • Please complete this form for one of your cats. After you finish booking and submit, you will be taken to a history form to fill for your other cat - no additional deposit or booking needed. 

  • Pet's Date of Birth *
     - -
    2 digit day, 2 digit month, 4 digit year
  • Pet's Sex*
  • Is your cat declawed?*
  • Where did you obtain your cat?*
  • Date your cat joined your household*
     - -
    2 digit day, 2 digit month, 4 digit year
  • How many previous owners has your cat had (not including breeder, but including fosters)?*
  • Format: (000) 000-0000.

  • Household Information

  • Please list the people (including yourself) currently living within the household *
    Rows
  • Please list all pets in the household (including the patient) in the order they were obtained. Please enter N/A if not applicable*
    Rows
  • Household changes that have occurred since acquiring your pet - Please select all that apply*
  • Living Environment - Please select all that apply*
  • Cat's lifestyle/Outdoor Access*

  • Behaviour Concerns

    Some portions of this section may not apply to your pet, but the information you provide helps us build a more complete picture for your assessment. We appreciate any details you're able to share.
  • The main behavioural concerns for my pet include (please select all that apply):*

  • Describe a recent, specific example. Please try to include:

    • Approximate date
    • What happened
    • Where it occurred and who (people/animals) was present or nearby
    • Your pet's body language before/during/after (if observed)
    • Anything happening around your pet at the time.

    Multiple examples can be provided if available

  • Describe a recent, specific example. Please try to include:

    • Approximate date
    • What happened
    • Where it occurred and who (people/animals) was present or nearby
    • Your pet's body language before/during/after (if observed)
    • Anything happening around your pet at the time.

    Multiple examples can be provided if available

  • Describe a recent, specific example. Please try to include:

    • Approximate date
    • What happened
    • Where it occurred and who (people/animals) was present or nearby
    • Your pet's body language before/during/after (if observed)
    • Anything happening around your pet at the time.

    Multiple examples can be provided if available

  • Videos of Behaviour Concerns

  • If you have any videos and/or photos of the concerning behaviour, please upload them here.

    If you don't currently have any, but can safely capture some before the appointment, please bring them to share with Dr. Squair or email them to hello@prairiecrocusbehaviour.com prior to the appointment.

    Please do NOT attempt to capture footage in any situation where a person or animal could be harmed. Do not provoke aggression or reactivity just to get it on video. Dr. Squair doesn't need to witness these behaviours firsthand to evaluate your pet - discussing behaviour patterns and history, along with assessing body language in clinic, gives her a clear clinical picture.

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  • Aggression Screening

    E.g. Tense posture, intense/hard stare, growling, lunging, snapping, biting
  • Has your cat ever bitten or attempted to bite a person?*
  • Who is your cat aggressive toward? Select all that apply*
  • Bite pattern observed toward PEOPLE? Select all that apply*
  • If your cat has bitten a person(s), what injuries were sustained? Mark all that apply.*
  • Total number of bites to PEOPLE - TOUCHED skin*
  • Total number of bites to PEOPLE - BROKE skin*
  • Has your cat ever bitten or attempted to bite a pet (another cat or other animal)?*
  • Pets your cat has shown aggression toward? Select all that apply*
  • If your cat is aggressive to another cat in the home, indicate the triggering situations.
  • Has your cat displayed any of the following behaviors towards other animals?
  • Bite pattern observed toward PETS? Select all that apply*
  • If your cat has bitten a pet(s), what injuries were sustained? Mark all that apply.*
  • Total number of bites to PETS - TOUCHED skin*
  • Total number of bites to PETS - BROKE skin*

  • Relationship Among Household Cats

    Skip this section if the patient is the only cat in the household.
  • Do you notice any of the following between the patient and the cat listed above? Check all that apply.
  • Do you notice any of the following between the patient and the cat listed above? Check all that apply.

  • Elimination Behaviours

  • Litter Box - Please list the details of each box in order of most likely to least likely to be used*
    Rows

  • E.g. Upstairs bathroom, large size, uncovered, clumping litter

  • How often do you scoop the litter boxes*
  • How often do you change the litter and clean the boxes?*
  • Does your cat reliably use the litter box?*
  • How do you clean the soiled areas outside of the box?*

  • Urination

  • How often does your cat urinate outside the box?*
  • When your cat urinates, do you notice any of the following? Check all that apply.*
  • Where outside the box does your cat urinate? Check all that apply.*
  • Does your cat dig with their front paws before or after urinating?*

  • Defecation

  • How often does your cat defecate outside the box?*
  • How many times per week does your cat defecate in total?*
  • What is the consistency of your cat's stool? Check all that apply.*
  • Where does your cat defecate outside the box? Select all that apply*
  • Does your cat dig with their front paws before or after defecating?*

  • General Behaviour Screening

  • Behaviour Patterns within the Home

  • How do you react when your cat behaves in an undesired way? Check all that apply.*
  • Which of the following best describe your cat's sleep pattern?*
  • Which behaviors do you observe with a VISITOR? Please select all that apply*
  • If you or another family member handle your cat, which behaviors do you observe?Please indicate all that apply*
    Rows

  • Environment and Behaviours when Separated

  • Do you have any concern that your cat is anxious when you are gone?*
  • What does your cat do when you prepare to leave? Check all that apply.*
  • Do you have a camera in the home to observe your cat when you are away?*
  • When your cat has been left home alone, do you typically come home to find that your cat was sleeping?*

  • Response to Noises

  • How does your cat respond to the following noises? Please indicate all that apply*
    Rows

  • Compulsive Behaviours

  • Does your cat exhibit any of the following to the point of interfering with normal function?*

  • Age-Related Changes

  • **This section of the history form is to be completed only if your dog is older (> 5 or 6 years for larger dogs and > 10 years for smaller ones) so that we can assess changes associated with aging

    If your dog is not elderly or you have no complaints that could be associated with age, you do not have to complete this section.  If you are uncertain, please complete the section.

  • Equipment and Tools

  • Please indicate equipment you use with your cat*
  • Please indicate the tools you use with your cat*
  • Based on your pet's response, do you feel that the tools/methods that you currently use are effective?*
  • How does your cat respond to catnip?*

  • Diet and Feeding

  • Does your cat have any diet restrictions?*
  • How often do you offer food?*
  • How is the food presented/offered?*
  • Does your cat finish all of the food?*

  • Medical History

    Previous and current medications, major medical history
  • Is your cat currently on any medications or supplements?*
  • Please list current medications and supplements your cat receives, OTHER THAN FOR BEHAVIOUR - if not applicable, enter N/A in box 1*
    Rows

  • E.g. Prednisolone, 5 mg, tablet, 1/2 tablet (2.5 mg), once daily, 8 am, Dec 2025

  • Please list current medications your cat receives as prescribed specifically for BEHAVIOUR - if not applicable, enter N/A in box 1*
    Rows

  • E.g. Gabapentin, 100 mg, capsule, 1 capsule (100 mg), twice daily, 8 am and 8 pm, April 2025

  • Has your cat ever been prescribed behaviour medication(s) in the past?*

  • Your Goals and Sentiments

  • Do you feel that your goals or expectations for your pet are attainable?*
  • What are your feeling on the potential use of medications IF recommended as part of your pet's treatment plan?*
  • We understand that living with a pet who is experiencing behavioural challenges can be difficult, and it can affect many parts of your daily life together. To help us better understand your relationship with your pet, please select all of the following that apply to how you currently feel:*
  • Are you concerned that you may have caused the problem?*
  • Do you feel guilty about the problem*
  • Are you considering finding another home for your cat due to behaviour concerns?*
  • If yes or maybe, is this something you would like to discuss during your appointment?*
  • Are you considering euthanasia due to behaviour concerns?*
  • If yes or maybe, is this something you would like to discuss during your appointment?*
  • Has anyone said that you should euthanize your cat?*
  • Did you seek help prior to this appointment?*
  • If yes, please indicate who you have received help from*

  • This deposit secures your place to book a consultation and goes toward the total cost of the appointment. The remainder of the appointment cost ($245 CAD + GST) will be due at the end of your consultation appointment. Following payment, you will then gain access to the Prairie Crocus Veterinary Behavioural Medicine calendar on the next pageand can schedule yourself in an appointment slot that works best with your schedule.

    If there are any problems, issues, or questions that arise, please reach out by email to hello@prairiecrocusbehaviour.com. Thank you!

     

    **If you are scheduling an Out-of-Province Collaborative Consultation the appointment will take place online. On the next page, please select the appointment time that works best for you. The remainder of the appointment cost ($150 + GST) will be invoiced following the consultation appointment 

  • Prairie Crocus Veterinary Behavioural Medicine Feline Appt Deposit*

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      Feline Behavioural Diagnostic Consultation Deposit


      $150.00 CAD$150.00CAD
        
      Total
      $0.00 CAD$0.00CAD

      Credit Card

    • Thank you for completing your history form and confirming your deposit.

      Please schedule your appointment time using the button below - first scheduling the 90 min virtual appointment slot, and then the 15 min in-person appointment (for clients in Manitoba). A Zoom link will be automatically sent to your email and in appointment reminder messages. Please select the slot that works best for your schedule (and anyone else who may attend).

      We encourage all primary caregivers, including partners and involved teenagers, to attend so everyone is on the same page with the plan. 

      Once you have selected an appointment slot, press Submit at the bottom of the next page to send your information to Dr. Squair for review ahead of your appointment.

      If there are any problems, issues, or questions that arise, please reach out by email to hello@prairiecrocusbehaviour.com. Thank you!

       

    • Feline Behaviour Diagnostic Consultation - Zoom Meeting*
    • Feline In-Clinic Observation Appointment*

    • Information for In-Clinic Visits

      The initial 60-90 min appointment is conducted online. Following this there is a brief 15 minute appointment in-clinic with Dr. Squair to establish care.

    • We strongly recommend that all primary caregivers in the household, including spouses, partners, and any teenagers substantially involved in your pet's care, attend the initial appointment. This helps ensure everyone shares a unified understanding of the diagnosis, recommendations, and behaviour modification plan from the outset.

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