Feline Medicine Questionnaire Name*Patient Name*Date MM slash DD slash YYYY Age*SexFemaleMaleBreed*How many cats do you have?*What percentage of the time are the cats inside?What type of litter do you use?How many litter boxes are there?How often do you change the litter box?If you have more than 1 cat, do they eat out of the same bowls?YESNODoes your cat(s) every miss the litter box?YESNOWhat diet do you feed your cat(s)?Do you feed treats?YESNOIF SO: please describeDoes your cat like to chew on nonfood items?YESNOIF SO: please describeHow does your cat’s hair coat look?goodbad hair daypoorHow is your cat’s back muscles?smoothsome muscle lossboneyHow is your cat’s weight trending over the last year?getting heavierabout the samelosing weightHow often does your cat vomit?How many hours per day does your cat sleep?Has your cat had any anxiety concerns arriving at an Animal Hospital in the past including the car ride or being handled?YESNOIF SO: please describe:Feel free to share any concerns you have:Has your feline pet been diagnosed by a Veterinarian with medical conditions in the past?YESNOIF SO: please describe:List any medications that your kitty is taking at this time:
