Feline / Kitten Wellness Exam Questionnaire

Wellness visits allow us to check for early signs of illness, provide preventive care like vaccines and parasite protection, and discuss nutrition and behavior. This questionnaire helps us learn more about your cat’s lifestyle and health so we can provide the best care possible.

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About This Form

By completing this Feline / Kitten Wellness Exam Questionnaire, you provide our veterinary team with valuable information about your cat’s diet, behavior, lifestyle, and health history. This helps us tailor preventive care recommendations and keep your cat thriving at every stage of life.

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

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? *

Is Your Pet Displaying Any Behaviors That Cause You Concern? *

Has Your Pet Ever Had a Reaction to Vaccines? *

Medications

Is Your Pet on Any Medications? *

Include Heartworm and Flea Prevention

Feline / Kitten Wellness Exam Questionnaire

About This Form

Client Information

Pet Information

Medications

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