Feline Illness Exam Questionnaire

Cats often hide signs of illness, making it especially important to gather a thorough history when they’re not feeling well. This questionnaire helps our veterinary team better understand your cat’s symptoms, lifestyle, and environment so we can provide accurate diagnostics and treatment.

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About This Form

By completing this Feline Illness Exam Questionnaire, you give our veterinary team essential details about your cat’s health and daily habits. This information helps us identify possible causes of illness and create the best care plan for your feline companion.

Client Information

Owner's Name *

First

Last

Phone Number *

Please enter a valid phone number.

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Pet Information

Pet’s Name *

Pet's Date of Birth

What Is Your Pet Here for Today? *

How Is Your Pet’s Appetite? *

How Is Your Pet’s Water Intake? *

Any Changes in Your Pet’s Urination? *

How Is Your Pet’s Energy Level? *

Does Your Pet Have Any Abnormal Licking or Scratching? *

Does Your Cat Ever Go Outside? *

What Brand of Food Do You Feed Your Pet? *

How Much Does Your Pet Get (½ Cup, 1 Can) and How Often? *

Medications

Is Your Pet on Any Medications? *

Include Heartworm and Flea Prevention

Feline Illness Exam Questionnaire

About This Form

Client Information

Pet Information

Medications

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