Cat Lifestyle Questionnaire

MOUNTAIN VIEW VETERINARY HOSPITAL

Cat Lifestyle Questionnaire
Please answer the following questions to help us individualize Your Pet's vaccine and health recommendations:
Owner
Pet's Name:
Pet's Breed
How old was he/she when you got him/her?
When did you get him/her? (month/year)
Where did you get your pet?
Which statement best describes your cat?

Totally indoors, won't go out ever (Except on a leash or in an enclosure).Totally indoors but I am afraid they may escape.Indoor, but occasionally escapes.Indoor, but will run outside if the opportunity presents itself.Indoor/OutdoorTotally outdoors
Which States has Your Pet lived in?
Does he/she travel with you outside Western Washington?

YesNo
If so, where?
How often?
When is your next visit?
Does your cat ever go to a boarding kennel?

YesNo
Which kennel?
How often?
When is your next visit?
Do you regularly train, show, or take him/her to a groomer?

YesNo
Which groomer?
Does he/she fight with other cats?

YesNo
Has he/she ever had an abscess?

YesNo
Do you have a cat with Feline Leukemia or FIV (Feline AIDS) in your house or any house your cat visits?

YesNo
Do you foster other pets or have other pets visit your household?

YesNo
Has he/she ever had an adverse reaction to vaccines before?

YesNo
Please give details:
Has he/she ever had an adverse reaction to any medications?

YesNo
Which medications?
Does he/she have any food or other allergies?

YesNo
What are they allergic to?
Have you added any new pets since his/her last visit?

YesNo
Thank you for helping us provide the best preventative care for Your Pet!
Do you have any questions or concerns about his/her overall health today?
Should be Empty:

MOUNTAIN VIEW VETERINARY HOSPITAL