Feline Annual Wellness Pre-Exam History Form in Crosslake, MN

Name*

First Last

Pet's Name*

Phone*

Have there been any changes to your cat’s behavior since his/her last wellness exam?*

Yes
No

Comments

What brand of food do you feed your cat and how much volume of that food does your cat eat per day?*

Any special treats your cat receives on a routine basis?*

Have there been any changes to your cat’s eating or drinking habits?*

Is your cat urinating and defecating normally without any pain or discomfort?*

Yes
No

Comments

Is your cat urinating more than normal or in abnormal locations (not in the litterbox)?*

Yes
No

Comments

Has your pet had any vomiting or diarrhea recently? Does your pet have any history of consistent vomiting/diarrhea from time to time? If so, how often, on average?*

Has your cat been exhibiting any coughing or sneezing you are concerned about?*

Yes
No

Comments

Is there any abnormal eye discharge that you have noted?*

Yes
No

Comments

Does your cat have any occasional or continual limping you have noted?*

Yes
No

Comments

Is your cat grooming normally or have you noted any hair loss?*

Yes
No

Comments

Have you noted any new lumps or bumps on your pet you are worried about? Any previously discussed lumps that are changing significantly since the last wellness exam?*

Yes
No

Comments

Does your cat go outside, even if intermittently?*

Yes
No

Comments

Please indicate which products your cat receives for routine heartworm prevention as well as flea and tick control. Please also note how often these products are administered.

Is your cat taking any other prescription medications or supplements? If so, please list each medication you administer.