Feline Annual Physical Questionnaire

Please take a moment to complete these questions in advance of your cat’s annual examination appointment. It will help our doctors to understand your cats’ diet, lifestyle, and environment. In understanding these areas, we can specifically tailor a health regime perfectly suited to her/him.

Name *

First

Last

Pet's Name *

Habitat *IndoorOutoorIn and out freely

Appetite *ExcellentGoodPickyPoor

Food Type *KibbleKibble & CannedCanned OnlyRaw

Diet Frequency *Once DailyTwice DailyThree Times DailyFree Fed

Diet Brand *

Water Consumption *Drinks normal amountDrinks excessive amountDoesn't drink a lot

Activity Level *NormalHigh levelSedentary

Do you have any other pets in your home? If so, please list *

Does your cat go to a grooming or boarding facility? *Yes, bothGroomingBoardingNo

Do you travel with your cat to destination places (cottages, out of province, USA, etc)? If so, please indicate your places of travel. *

If they do travel with you, please indicate where:

Does your cat hunt? *YesNo

If you cat does hunt, does (s)he eat the prey?YesNo

Does your cat vomit? *My cat does not vomitMy cat vomits occasionallyMy cat vomits excessively

Does your cat persistently cough? *My cat does not coughMy cat coughs occasionallyMy cat coughs excessively

Does your cat persistently sneeze? *My cat does not sneezeMy cat sneezes occasionallyMy cat sneezes excessively

Does your cat persistently itch? *NoYes

If your cat does scratch, please list the location(s) on his/her body:

Has your cat experienced any mobility issues? *ConstantIntermittentNo

If your cat has experienced lameness, please specify which leg(s) and the duration:

Have you noticed any fleas or ticks on your cat recently? *NoYes

Do you apply flea prevention? *NoYes

Please list all medications and supplements your pet is on: *

Has your cat been involved and/or injured in any fights (cats, raccoons, etc) within the past 2 years? *YesNoUnsure

Have you noticed any lumps you would like to have checked? If so, please list the location(s) on body. *

Our clinic is 'Fear Free' and the veterinarians and team take into account not only your pet's physical well-being, but also their emotional well-being.

During past veterinary visits, what level would you classify your pet as on the Spectrum of FAS (Fear, Anxiety and Stress)? *FAS 0FAS 0-1FAS 1FAS 2FAS 3FAS 4FAS 5

Are there any additional concerns you would like to discuss at your cat's annual appointment?

Lastly, please describe which number best describes your pet's stool? *1234567

Thank you for your time in helping us understand your pet better. Together we can continue to preserve that special bond!

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