ARLINGTON CAT CLINIC – Diarrhea Questionnaire

1

How long has the diarrhea been present?* This field is required.

2

Is the diarrhea more severe now than a few days ago? * This field is required.

3

Select the description of each item that applies:

Consistency
Watery stool
Stool is the thickness of pancake batter

Blood
Very bloody stool
Only sporadic blood present
Blood not present in stool
Bright red blood present
Dark, tarry blood present

Degree/Frequency
Entire stool is soft and watery
Only portions of the stool are soft and watery
Diarrhea with each bowel movement
Only 1 or 2 bowel movements per day     More than 4 bowel movements per day

4

Color
Stool is dark brown in color
Stool is very pale in color
Stool is black and tarry in appearance

Miscellaneous
Thick mucus or pieces of tissue present in stool
Loss of bowel control (defecates in the house on the floor)
Severe straining when having a bowel movement

5

What is the normal consistency and appearance of your cat's stool?* This field is required.

6

Is your cat's appetite normal? * This field is required.

Yes

No

7

If not, is it eating at all?

8

What have you been feeding your cat during the last week? (Including dog or cat food, treats, table foods, milk, and anything else that it gets on a daily basis or has access to. (Also state what percentage of the diet is each item or category).

9

Has there been a significant diet change in the last few weeks?

10

If so, does that correspond with the onset of the diarrhea?

11

Is your cat as active as normal?

12

Describe any change in, water consumption? (up or down)

13

Has vomiting been occurring?

14

Client Info* This field is required.

Client Name

Pet's Name

Email

Phone Number