Feline Health Questionnaire (Annual 2-9 years of age) Date MM slash DD slash YYYY Owner’s Name:Pronouns (optional)Address Street Address City Province/Region Postal Code United StatesCanada Country Home NumberCell NumberWork NumberWhich of the above numbers do you prefer as primary contact number?Email Emergency Contact (other than immediate family):Phone NumberPet’s Name:Breed:Colour:Sex Male Female Neutered Spayed Age / Birthday ALL NEW PETS SHOULD BRING or REQUEST MEDICAL RECORDS BE SENT TO INFO@LYNWOODANIMALHOSPITAL.COM 1. Have you noticed any of the following: Lethargy Limping Bad breath Increased drinking or eating habits Decreased drinking or eating habits Changes in Urination Diarrhea Constipation Coughing or Labored Breathing Sneezing Vomiting Hairballs Scratching Licking Scooting New (or changing) Lumps or Bumps 2. What diet are you currently feeding your cat?Please indicate brand of food, amounts, and how often for each of the following:Dry kibbleCanned foodTreats/other Add Remove3. What parasite preventive are you using for your cat? Nexgard combo Advantage Profender Milbemax Other (select all that apply)OtherLast administered?4. Is your cat currently on ANY supplement or medication (incl. vitamins, probiotics, omegas, glucosamine, etc)? Yes No If yes, please indicate how often and amounts.Supplement / MedicationHow often?Amount Add Remove5. What type of dental care do you provide for your cat? None Brushing daily/every other day Brushing other Dental diet Dental treats Dental at the groomers Water additive Other (please indicate) Others(Required)6. Does your cat do any of the following: Boarding Go to the groomers Travel with You Have contact with other animals Go outside on a leash Go outside in an enclosed location (eg, Catio) Free to roam outside unsupervised 7. Do you have other pets? Yes No If yes, how many and what species?SpeciesHow many? Add RemoveIf applicable, are they currently vaccinated and on parasite preventive? Yes No 8. What type of litter does your cat use?a. How often do you clean your cat’s litterbox?b. How many do you have, and where are they located?9. Is there anyone in contact with your cat who has an immunocompromised condition (ie, diabetes, pregnancy, cancer, children <5yrs, seniors >65yrs)? Yes No 10. Are there any health issues or behaviors you wish to discuss? Yes No a. If yes, please indicate:11. Does your cat have a microchip? Yes No If yes, please indicate microchip number:12. Does your cat carry pet insurance? Yes No If yes, please indicate insurer and policy number: