Feline Health Questionnaire Form Owner’s NameDateAddressPostal CodePhone numbers (home)(cell)(work)Email Emerg. Contact(other than immediate family):ph:Pet’s NameBreedColourSexMaleFemaleNeuteredSpayedAge or BirthdayWhat brand of food do you feed your cat? How much do you feed?Where does your cat sleep?What parasite preventive are you using?Last administered?What type of dental care do you provide for your cat?Do you have other pets?YESNOAre they currently vaccinated and on hea rtworm and pa rasite preventive?YESNODoes your cat enjoy going outside?When was your cat’s last dental cleaning under general anaesthesia?Does your cat: Board Groom Travel with You Have contact with other animals Have you noticed any lumps or bumps on your cat?YESNOHave you noticed any of the following: Hacking or Labored Breathing Limping Lethargy Diarrhea Increased Thirst Increased Urination Vomiting Constipation Dry, Lusterless Fur Sneezing or Panting Are there any health issues or behaviors you wish to discuss?YESNOIf yesAre there any behaviors you wish you could change?YESNOIs your pet currently on ANY medication (incl. A spirin, glucosamine, etc)?YESNOIf yes, frequency and amounts that are givenPhoneThis field is for validation purposes and should be left unchanged.
