Prescription Refill and Food Order Request Form

Feline Annual Physical Questionnaire

Please take a moment to complete these questions in advance of your cat's annual examination appointment. It will help our doctors to understand your cats' diet, lifestyle, and environment. In understanding these areas, we can specifically tailor a health regime perfectly suited to her/him.

Name*
First Last
Pet's Name*
Habitat*
Appetite*
Food Type*
Diet Frequency*
Diet Brand*
Water Consumption*
Activity Level*
Do you have any other pets in your home? If so, please list*
Does your cat go to a grooming or boarding facility?*
Do you travel with your cat to destination places (cottages, out of province, USA, etc)? If so, please indicate your places of travel.*
If they do travel with you, please indicate where:
Does your cat hunt?*
If you cat does hunt, does (s)he eat the prey?
Does your cat vomit?*
Does your cat persistently cough?*
Does your cat persistently sneeze?*
Does your cat persistently itch?*
If your cat does scratch, please list the location(s) on his/her body:
Has your cat experienced any mobility issues?*
If your cat has experienced lameness, please specify which leg(s) and the duration:
Have you noticed any fleas or ticks on your cat recently?*
Do you apply flea prevention?*
Please list all medications and supplements your pet is on:*
Has your cat been involved and/or injured in any fights (cats, raccoons, etc) within the past 2 years?*
Have you noticed any lumps you would like to have checked? If so, please list the location(s) on body.*
Our clinic is 'Fear Free' and the veterinarians and team take into account not only your pet's physical well-being, but also their emotional well-being.
During past veterinary visits, what level would you classify your pet as on the Spectrum of FAS (Fear, Anxiety and Stress)?*
Are there any additional concerns you would like to discuss at your cat's annual appointment?
Lastly, please describe which number best describes your pet's stool?**
Thank you for your time in helping us understand your pet better. Together we can continue to preserve that special bond!