Feline Health Questionnaire

FELINE HEALTH QUESTIONNAIRE
Name of Pet*
Last Name*
Date of Appointment*

MonthDayYear
Date
Time of Appointment*

Hour Minutes

AM/PM Option
Reason for Exam*

Recheck ExamWellness ExamMedical Exam
What issue or concerns do you have for your pet?*
Any new bumps or lumps?*

NoYes
Any changes in energy?*

NoYes
Is your pet having trouble getting around?*

NoYes
Have you noticed any itching or scratching?*

NoYes
Any behavior changes with your pet?*

NoYes
Have you noticed any changes in eye sight?*

NoYes
Does your cat go outside?*

NoYes
Eating and Drinking
What food is your pet currently eating?*
How much are you feeding each day?*
Any changes in water intake?*

Drinking MoreDrinking LessNo Change
Litter Box Habits and Diarrhea
Has your pet gotten into anything or eaten anything they shouldn't have, ie socks, toys, or trash?*

NoYes
Any changes in your pet's bowel movements?*

NoYes
Any blood seen in stool?*

NoYes
If your pet is experincing diarrhea or has blood in their stool please bring a fresh stool sample.
Has your pet vomited recently?*

NoYes
Any accidents outside of the litterbox?*

NoYes
Any straining in the litterbox?*

NoYes
Current Medications
Please list any medications and dosages your pet is currently on.*
What heartworm, intestinal parasite, and flea/tick prevention is your pet on?*
Do you need a refill of prevention or medications?*

NoYes
Has your pet missed more than one dose?*

NoYes
Any questions for your vet?*
Does your pet need a nail trim?*

NoYes
Our vets recommend blood work to be ran at least once a year, even for our young and healthy pets. Our blood work includes a complete blood cell count and blood chemistry.
Should be Empty:

FELINE HEALTH QUESTIONNAIRE

Eating and Drinking

Litter Box Habits and Diarrhea

Current Medications