Instructions
Please check all that apply to your cat:
Behavior / Neurologic My cat is just not acting like himself/herself.My cat interacts less with the family.My cat seems confused or disoriented.My cat has been meowing or whimpering for no apparent reason.My cat's sleeping patterns have changed.My cat has had tremors or episodes of shaking.My cat has displayed circling, head tilts or repetitive movements. Body Functions My cat has bad breath.My cat has difficulty chewing.My cat's appetite has increased/decreased.My cat has gained / lost weight.My cat is drinking more water than usual.My cat is urinating more frequently than usual.My cat's litter-box habits have changed and he/she sometimes has accidents.My cat's bowel habits have changed (increased frequency, diarrhea, constipation, straining).My cat vomits more than occasionally.My cat seems to have trouble seeing or hearing.My cat has blood in her/his urine and/or stool.My cat has had bouts of weakness or suddenly collapsed. Heart / Lungs My cat has been coughing or sneezing or wheezing.My cat seems to be panting more or having open mouth breathing.My cat tires more rapidly or seems short of breath. Activity/Orthopedics I have noticed a change in my cat's behavior or activity level.My cat has difficulty jumping to furniture/bed.My cat seems limp or seems stiff and has difficulty rising from a resting position.My cat show signs of pain (hiding, unusually quiet, or vocalizing).My cat goes outside. What type of housing do you live in? Skin and Coat My cat scratches, licks or chews excessivelyMy cat has changes in haircoat, skin, or new lumps or bumps.My cat's skin has an odor and/or I have noticed changes in grooming habits.My cat has bald spots. What foods and treats are you currently feeding your cat? How often? And how much?
Please list current medications/supplements:
Do you have any specific questions or concerns about your cat?
Pet Name
Owner Name
Owner Email
Date
