Patient History Required for all office visitsOwner's Name* First Last Cat's Name*Age*Phone*Are texts okay?*YesNoEmail* Diet: My cat eats (Mark all that apply) Dry food Canned or semi-moist food Treats People foodBrand of food my pet eatsType of people food my pet eatsMy cat (Mark all that apply): Is a picky eater Will only eat dry food Will only eat canned food Will eat most types of cat food Is always begging for foodMy cat (Mark the choice that applies best to your cat): Is always inside and never sneaks outside Is mostly inside, but occasionally goes/sneaks outside Goes inside and outside Is always outsideMy cat (Mark the choice that applies best to your cat): Never comes in contact with other cats Only comes in contact with the cats in our household May come in contact with cats other than in our householdHow many cats are in your household including this cat?*If there are other cats in your household, do they go/sneak outside?*YesNoN/AAre all the cats in the home currently vaccinated and on heartworm and flea preventive?*YesNoN/AAre there dogs in the home? If yes, are they currently vaccinated and on heartworm and flea preventive?*YesNoN/AIs your pet currently having problems with:*FleasTicksNeitherAre there children, expectant mothers or immunocompromised people exposed to your pet?*YesNoIs your pet on monthly parasite preventative? If Yes, what brand?Last date given Date Format: MM slash DD slash YYYY How consistent does your cat receive heartworm preventive?Same time every monthYear roundSometimes a few daysLateMay miss a monthDo not give in winterName (ex: Amlodipine)Dose (ex: 5mg)How often (ex: 1 per day)Please check any conditions that apply to your pet: Vomiting Incontinence Increased thirst Sneezing Behavioral changes Clawing Difficulty jumping Vision problems Underweight Diarrhea Litter box problems Decreased appetite Itchy skin Destructive Biting Seizures Scratching Decreased grooming Constipation Frequent urination Coughing Skin lumps and bumps Aggression Limping Hearing problems OverweightIs there anything else you would like the doctor to know?