Preventive Care Survey for Senior & Geriatric Cats (7yrs and over)
Cat’s Name
*
Your Name
*
First Name
Last Name
E-mail
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Is your cat microchipped?
Yes
No
Unsure
Please tell us about your cat’s diet.
*
Please tell us about any treats, dental chews, and human food your cat receives.
If your cat’s appetite has changed or if his/her eating habits have changed, please describe here.
*
Does your cat readily eat his/her food? If not, do you offer treats/human food to entice your cat to eat? Please describe here.
*
Does your cat have difficulty chewing or swallowing? Please describe here.
*
Has your cat had any weight fluctuations?
*
Yes
No
Has it become a challenge to maintain your cat’s weight?
*
Yes
No
Does your cat tolerate exercise and play like before?
*
Yes
No
Does your cat seem to be slow or painful when rising?
*
Yes
No
Does your cat seem more sensitive to your grooming or touching over the lower back/hips?
*
Yes
No
Does your cat wander aimlessly and/or seem disoriented?
*
Yes
No
Does your cat seem increasingly anxious, fearful, or irritable?
*
Yes
No
Has your cat exhibited any unusual vocalizations (ie. yowling for no apparent reason)?
*
Yes
No
Does your cat seem to act “old”?
*
Yes
No
Does your cat seem to enjoy life as much as before?
*
Yes
No
If your cat has had any behavior changes since his/her last visit, please describe here.
If you have any questions or concerns you would like to discuss with the doctor during your visit, please list them here.
Submit
Should be Empty: