Feline Medical History Form

Has your pet ever had a reaction to vaccines?


Has your pet ever had a history of seizures, or have they had one recently?


Does your pet ever strain to urinate?


In the last two weeks, has your cat experienced vomiting?


In the last two weeks, has your cat been coughing, sneezing, or gagging?


In the last two weeks, has your cat been lethargic?


In the last two weeks, has your cat experienced lameness, weakness, or stiffness?


In the last two weeks, has your cat experienced shaking of the head, scratching or hair loss?


In the last two weeks, has your cat been scooting it's rear?


In the last two weeks, has your cat experienced bad breath?


In the last two weeks, has your cat experiences diarrhea or constipation?


In the last two weeks, have you noticed any behavior changes?


In the last two weeks, have you noticed your cat passing any worms?


Is your pet allergic to any food or medication?


Is any member of your family allergic to peanut butter, turkey or beef?


Is your cat showing difficulty climbing up or down stairs?


Is your cat showing difficulty chasing moving object?


Is your cat showing difficulty jumping up or down?


Is your cat showing difficulty running?


Is your cat Energetic & Enthusiastic?



Is your cat Happy & Content?



Is your cat Active & Comfortable?



How is your cats drinking?



How is your cats appetite?



How is your cats urination?



How is your cats defecation?



Refills needed?



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