Annual Physical Exam Pre-Appointment Questionnaire
Contact Information Review
Please review and update the primary contact information we have on file.
Pet Name
Pet Name
Primary Owner Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Email(s)
Contact emails separated by comma
Phone Number
Please enter a valid phone number.
Any additional contact information updates?
Have there been any changes in the above contact information?
*
Yes, please update my file.
No, there have been no changes.
Is your cat insured?
Yes
No
Please provide the insurance provider details and policy number if there have been any changes. If we already have these details, feel free to skip this section.
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Diet, Medications and Supplements
What food does your cat eat?
Please list the brand and specific diet(s).
Does your cat receive meals at set times or have continuous access to food (free feeding)?
Meals at set time
Free Feeding
Both
Could you please specify the quantity and frequency of your cat's meals, including how much food (in cups, grams, etc.) is given and how often (e.g., twice a day, morning and evening)?
What treats does your cat get?
Please list the brand and specific treat(s).
Does your cat ever get "human foods"?
Yes
No
If Yes, please list the foods:
Please list the human foods that your kitty is receiving.
Did you notice any changes in your kitty's eating or drinking habits?
Yes
No
Please describe in detail the changes you noticed.
Is your cat currently on any medications?
Yes
No
Please list the medications, dosages, and administration schedule.
Is your cat currently getting any supplements?
Yes
No
Please list the supplements (and their dosages) your cat is on:
Are there any known or suspected allergies your cat is suffering from?
Yes
No
Please provide details, including the symptoms you've observed and the reasons you suspect an allergy.
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Behaviour and Lifestyle
Please describe your cat's typical daily exercise routine:
Does your cat ever go outside?
Yes
No
Is your cat's outdoor time supervised or unsupervised?
Supervised
Unsupervised
Please describe in detail for how long and how frequently is your cat spending time outdoors.
What preventive products do you use for intestinal parasites, heartworm disease, flea and tick control?
Is your cat experiencing any behavioural issues? Please select all that apply.
Inappropriate Elimination (peeing/pooping outside of the litter box)
Urine Marking
Increased Vocalization
Fearfulness
Aggression or Irritability
Hiding or Withdrawal
Over-Grooming
Activity Level Changes
Sleep Pattern Changes
Other
No Behavioural Issues Noticed
Please describe in detail all the behavioural issues and patterns you noticed. Ā Please indicate if these are recent or long-term changes. Has there been any stressful event or change in the household that might have affected your catās behaviour?Ā
Environmental factors such as changes in the household, new family members, or alterations in routine can significantly impact a cat's behaviour. However, cats are adept at hiding discomfort and illness, so any noticeable change in behaviour warrants attention.
Are there any other pets in your household?
Yes
No
Please provide details about the other pets in your household, including their species, breed, age, and any relevant information about their health or behaviour. If we have already met these pets during a previous visit, you can simply list their names:
This additional information will help the veterinarian gain a better understanding of the dynamics in your household and how they might affect your kitty's well-being and behaviour
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Oral Health
Do you brush your kitty's teeth? If so, how often?
Yes
No
Please let us know how often:
Is your cat experiencing any dental problems or symptoms (e.g., bad breath, difficulty eating, excessive drooling)?
Yes
No
If Yes, please describe them:
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Concerns
Are there any specific worries, concerns or questions you would like to discuss with the veterinarian during your kitty's Annual Physical Exam?
We'd love to learn more about your cat and what they mean to you! Please tell us what you love the most about your furry friend š± !
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Your furry friend's comfort is important to us. Is there anything specific about your kitty's preferences or behaviour (such as favourite treats, being more comfortable when held by you, etc) or any other things that can help us create a relaxed experience during the exam?
Since your last visit with us, has your cat been seen by another veterinarian (including at a cottage, specialist, or emergency clinic etc.)? Please let us know, as we may not have received their medical records. This information is vital to ensure we provide the best possible care for your pet
To help keep accurate and detailed medical notes, our doctors may choose to record audio during the appointment. We value your privacy - if you would like to opt out of voice recordings, please let us know:
*
Sure! The doctor may record our appointments.
I'd rather not - please opt me out of voice recordings.
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