Sick/ Injured Cat History

Your Name

First NameLast Name

Pet Name

Reason for visit

Is this a new health problem?

How long has this current episode of the problem been going on?

Is it getting better, worse, or staying the same?

Have you done anything at home for this problem?

What does your cat normally eat (Brand, variety, canned or dry, amount fed per meal or day)? Is you cat consuming the normal amount? If decreased, eating half of normal? One quarter?

Any change in thirst?

Any vomiting? If so, how many times a day or per week?

Any change in urine or bowel habits?

Any coughing, sneezing, or discharge from eyes?

Any other issues such as pain, limping, or changes in behavior?

What medications is your pet currently taking? Please include over-the-counter products, supplements, and flea and heartworms prevention.

Are any other members of the household affected?

Other information you would like to provide, including refills needed.