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Home » Feline Health Questionnaire

Feline Health Questionnaire

One of the challenging aspects of veterinary medicine is evaluating the health of patients who cannot talk to us. Remembering that pets age at a rate up to seven times faster than our own, makes this challenge even more important. As pet health care professionals, we depend greatly on the information provided to us by pet owners and family members. We would like to ask for your assistance.

In an effort to provide your pet with the best health care, we ask that you take just a few moments to answer the following questions. Making health care decisions with respect to age and lifestyle allows us to tailor our treatment and advice more effectively for every patient.

We thank you (and your pet thanks you) for your assistance toward this effort!

Step 1 of 10

10%

Which best describes your cat?

Indoors Exclusively

Outdoors/Indoors

Outside Exclusively

Please check your responses

Is wildlife in your area, including mice, squirrels, birds, possums, raccoons or skunks?(Required)

Do you ever take your pet to be groomed or boarded?(Required)

Do you provide foster care for other cats?(Required)

Do you ever handle unvaccinated cats?(Required)

Has your cat been FELV tested?(Required)

Has your cat been FIV tested?(Required)

Is any person in the household pregnant or trying to become pregnant?(Required)

Has your cat ever been treated for fight wounds?(Required)

Has your cat had a stool examination for intestinal parasites in the last year?(Required)

Is your cat currently on any medication for fleas?(Required)

If yes, please list drug(s), dose, & when dose was last given (including Heartworm prevention and Flea and Tick prevention):

Has your cat ever had any adverse reactions to vaccines in the past?(Required)

Have you ever seen ticks on your cat?(Required)

Does your cat sleep with you or your children?(Required)

What diet do you feed your cat?(Required)

Do you give any supplements (vitamins, herbal/holistic medications) to your pet? If yes, please list

Is your cat currently on any medications, if so what is the dosage you are giving and how often?

Which best describes your cat's breath?(Required)

Which best describes your cat's water consumption?(Required)

Please select any conditions that apply to your cat(Required)

Vomiting

Diarrhea

Constipation

Incontinence

Coughing

Skin growths

Itchy skin

Increased thirst

Frequent urination

Difficulty jumping

Limping

Difficulty with stairs

Seizures

Vision problems

Hearing problems

Behavioral changes

Other

None

Owner's Name(Required)

Pet's Name(Required)

Date(Required)

Do you already have an appointment scheduled with us?(Required)

Yes

What date and time is your appointment?

*Please note that the last available appointment on Saturday’s is 11:45 AM

Date

MM slash DD slash YYYY

Time

Hours

Minutes

AM/PM

Get in touch

913-642-2714

9425 W 75th Street,
Overland Park, KS 66204

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