Cat's name:

Your name:

Your email address:

How did your cat become a part of your family? (rescue, stray, breeder, friend/family, etc.)

If other, please explain:

Is your cat experiencing sneezing or coughing?

If yes, please explain:

Is your cat vomiting or having diarrhea?

If yes, please explain:

Have you noted if your cat’s breath smells bad or has a lot of tartar buildup?

If yes, please explain:

Have you noted any changes to the amount of water your cat drinks or urine production?

If yes, please explain:

Is your cat on a monthly heartworm preventative?

If yes, what brand?

When was the last does given?

Is your cat on a monthly flea and tick preventative?

If yes, what brand are you using?

When was the last dose given?

What brand of food do you feed your cat?

How much do you offer at each feeding?

How often do you offer food?

Have you noted any changes in your cat's activity?

If yes, please explain:

Have you noted any new lumps, bumps or sores that you are concerned about?

If yes, please explain:

Do you plan on having your pet boarded or groomed by a professional groomer?

Do you have any questions or concerns to discuss with your doctor?

If yes, please explain:

Do you need a refill of your cat's medication(s) while you are here?

Medication 1:

Medication 2:

Medication 3:

Do you have any concerns, complaints, or problems with urination in the house now?

Do you have any concerns, complaints, or problems with defecation in the house now?

Does your cat destroy any objects or anything else by chewing, sucking, or eliminating on them (eg, furniture, rugs, clothes, etc) now?

Does your cat seem overly stressed when going into a pet carrier, riding in the car, during the vet visit, or while boarding? (panting, yowling, urinating/defecating in the carrier).

If yes, please explain:

Does your pet show any reluctance to get in the carrier or car?

How would you describe your pet's behavior during travel? (select all that apply):

Eager & excited

Subdued

More quiet than usual

More vocal than usual

Does your pet do any of the following during travel?(select all that apply):

Pant

Tremble

Pace

Hide

Drool

Vomit

Poop

Pee

Has your pet ever been given any supplements or prescribed any medications to help manage his/her fear or anxiety associated with the visit? If so, what was it and what sort of results did you experience?

Does your cat live inside/outside/both?

Does your cat mouth, bite, suck, or nip anything or anyone?

Does your cat make any sounds about which you are concerned

Does your cat avoid, seem uncomfortable with or otherwise avoid loud noises (storms, fireworks)?

Does your cat show any signs of hissing, growling, or biting?

Have you ever been concerned that your cat is “aggressive” to people?

Have you ever been concerned that your cat is “aggressive” to cats?

Have you ever been concerned that your cat is “aggressive” to animals other than cats?

Has your cat ever bitten or clawed anyone, regardless of the circumstances?

Has anyone ever told you that they were afraid of your cat?

Has your cat had any changes in sleep habits?

Has your cat had any changes in eating habits?

Has your cat’s ability to move around, climb stairs, jump up on the couch, windowsill, or bed changed?

Is your cat behaving in any way that worries you or about which you would like more information?

If yes, please explain:

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Feline Wellness Screening Form

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