Fill out this questionnaire before each preventive care visit to help us be as thorough as possible during your appointment.Cat's Name Your Name First Last Preferred E-mail Preferred Phone Number Is this number a cell phone? Yes No Which method(s) of communication do you prefer? required Text Messaging Phone Call E-mail Is your cat micro-chipped with up-to-date registration? Yes No Unsure Please list your cat's current diet. (please specify brand, type, how much, and how often fed) Please list any treats, dental chews, and/or human food your cat receives. If your cat's appetite has changed or if his or her eating habits have changed, please give a detailed explanation below.Does your cat readily eat his or her food? If not, do you offer treats/human food to entice your cat to eat? Please explain below.Does your cat have difficulty chewing or swallowing? If so, please explain below.Has your cat had any weight fluctuations? Yes No Has it become a challenge to maintain your cat’s weight? Yes No Your cat's body condition is: required Overweight Ideal Underweight Unsure How much time does your cat spend outdoors? Does your cat hunt? Yes No Which parasite preventative(s) is your cat receiving? required Bravecto Plus None Other Specify How often is your cat receiving the parasite preventative? Please list all other medications and supplements your cat receives. Please include the current dose and frequency given.What type of home dental care does your cat receive? Preventive blood screening is an important way for us to spot potential health issues before your cat shows symptoms. It also allows us to obtain a baseline of blood values while your cat is healthy.Are you interested in adding on a wellness blood screen to your cat's visit? Yes Maybe No What size and how many litter boxes are available? Does your pet ever defecate or urinate outside the litter box? If so, please explain.Are the sides of the litter box low enough for a cat with athritis to easily enter? Yes No Does your cat drink or urinate more than previously? If so, please explain.Does your cat still run up and down stairs like before? Yes No Does your cat have easy access to his/her favorite resting places? Yes No Does your cat ever hesitate to jump on or off furniture? 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 pet 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 or her last visit, please describe them here.If you have any questions or concerns you would like to discuss with the doctor during your visit, please list them here.We look forward to seeing you and your pet at your upcoming appointment. Thank you for entrusting us with your pet’s care!
