Annual Cat Health Form
Cell Phone Number
My cat spends most of their time:
Outdoors on farm
My cat comes into contact with other cats....
While at home indoors
While bathed/professionally groomed
Is only indoor cat in household
My cat comes into contact with children?
Do you feed your cat at set feeding times
No, I free feed through out day.
What are you feeding your cat? Please include any table food or treats they get routinely.
Describe your cat's weight best...
Gained a few pounds since last visit
Needs to lose weight
Which best describes your cat's breath?(please choose one)
Not bad for a cat's breath
Really bad (Yuck)
Which best describes your cat's water consumption?
Same as last year
More than last year
Which best describes your cat's stool?
Which best describes how often your cat vomits?
Once in a while
When my cat vomits, it is usually ....?
Please check any of the conditions that your cat has experienced in the last year. (Check all that applies)
Change in appetite
Change in weight
Leaking or dribbling urine
Change in behavior
Crying /meowing more than normal
Itching or chewing
Is your cat limping, or showing signs of pain when walking?
Is your cat currently taking any medications, other than ones dispensed from our hospital?
What heartworm / flea control is your pet currently on?
If not on heartworm/ flea control type None
Please list medication you need refilled today.
Please list any issues you would like for our veterinarian to address.
Should be Empty: