Feline Health Questionnaire

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

Month Day Year
Date
Time of Appointment *

Hour Minutes

AM/PM Option
Reason for Exam *

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

No Yes
Any changes in energy? *

No Yes
Is your pet having trouble getting around? *

No Yes
Have you noticed any itching or scratching? *

No Yes
Any behavior changes with your pet? *

No Yes
Have you noticed any changes in eye sight? *

No Yes
Does your cat go outside? *

No Yes
Eating and Drinking
What food is your pet currently eating? *
How much are you feeding each day? *
Any changes in water intake? *

Drinking More Drinking Less No Change
Litter Box Habits and Diarrhea
Has your pet gotten into anything or eaten anything they shouldn't have, ie socks, toys, or trash? *

No Yes
Any changes in your pet's bowel movements? *

No Yes
Any blood seen in stool? *

No Yes
If your pet is experincing diarrhea or has blood in their stool please bring a fresh stool sample.
Has your pet vomited recently? *

No Yes
Any accidents outside of the litterbox? *

No Yes
Any straining in the litterbox? *

No Yes
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? *

No Yes
Has your pet missed more than one dose? *

No Yes
Any questions for your vet? *
Does your pet need a nail trim? *

No Yes
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