Pet's Name *
Habitat * Indoor Outoor In and out freely
Appetite * Excellent Good Picky Poor
Food Type * Kibble Kibble & Canned Canned Only Raw
Diet Frequency * Once Daily Twice Daily Three Times Daily Free Fed
Diet Brand *
Water Consumption * Drinks normal amount Drinks excessive amount Doesn't drink a lot
Activity Level * Normal High level Sedentary
Do you have any other pets in your home? If so, please list *
Does your cat go to a grooming or boarding facility? * Yes, both Grooming Boarding No
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? * Yes No
If you cat does hunt, does (s)he eat the prey? Yes No
Does your cat vomit? * My cat does not vomit My cat vomits occasionally My cat vomits excessively
Does your cat persistently cough? * My cat does not cough My cat coughs occasionally My cat coughs excessively
Does your cat persistently sneeze? * My cat does not sneeze My cat sneezes occasionally My cat sneezes excessively
Does your cat persistently itch? * No Yes
If your cat does scratch, please list the location(s) on his/her body:
Has your cat experienced any mobility issues? * Constant Intermittent No
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? * No Yes
Do you apply flea prevention? * No Yes
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? * Yes No Unsure
Have you noticed any lumps you would like to have checked? If so, please list the location(s) on body. *
During past veterinary visits, what level would you classify your pet as on the Spectrum of FAS (Fear, Anxiety and Stress)? * FAS 0 FAS 0-1 FAS 1 FAS 2 FAS 3 FAS 4 FAS 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? * 1 2 3 4 5 6 7
