Owner Information

Name*

First Last

Phone*

Email*

Date of My Pet's Appointment*

Pet Information

Name*

Is this pet new to us?

Date of Birth

Sex

Breed

Colour(s)

Markings

Microchip?

Tattoo?

Pet Medical History

My cat is...

My neighbourhood location is...

Number of cats in my household

How long have you had your cat?

Where did you get your cat?

Is your cat exposed to other outdoor cats?

Is your cat exposed to dogs?

My cat is exposed to indoor dogs

Yes
No

My cat is exposed to outdoor dogs

Yes
No

Do you take your cat to boarding?*

Yes
No

Do you take your cat to grooming?*

Yes
No

Do you take your cat to the pet store?*

Yes
No

Do you have any plans/have you ever adopted/fostered strays/shelter animals?

List any prescription or over the counter medication your cat is taking including flea products, vitamins, supplements, topical, etc.

What food does your cat eat and what treats do you feed?

Has your pet been vomiting?*

Yes
No

Has your pet had diarrhea?*

Yes
No

Has your pet been limping?*

Yes
No

Has your pet been itching?*

Yes
No

Has your pet had a change in appetite?*

Yes
No

Has your pet had a change in thirst?*

Yes
No

Has your pet had a decrease or increase in urination?*

Yes
No

List any health or behavior concerns regarding your cat you would like the veterinarian to address today

Would you like your cat to receive a nail trim ($23.25 plus tax)*

Yes
No

Would you like your cat to receive anal gland expression ($33.30 plus tax)*

Yes
No

Would you like your cat to receive ear cleaning ($23.20 plus tax)*

Yes
No

Other, please specify.

Have you noticed any lumps you would like to have checked?

Please provide details, including approximate location on your cat.

Senior Wellness Panel*/and or on chronic meds*

This is a comprehensive blood panel recommended yearly for all cats over 6 years of age. Having bloodwork done for geriatric pets is crucial for longevity, early detection of disease and management of conditions. Approximate cost is $265 (including cbc/chemistry/t4)

Cat Wellness Visit History Form

Owner Information

Pet Information

Pet Medical History

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