Preventive Care Survey For Senior and Geriatric Cats(7yrs and over)

Preventive Care Survey For Senior and Geriatric Cats(7yrs and over)

Please provide your details below and we will get back to you shortly.

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Cat’s Name *

Your Name *

First

Last

Email *

Phone Number

Is your cat microchipped?

• Yes
• No
• Unsure

Please tell us about your cat’s diet.

Please tell us about any treats, dental chews, and human food your cat receives.

If your cat’s appetite has changed or if his/her eating habits have changed, please describe here. *

appetite receives. cat

Does your cat readily eat his/her food? If not, do you offer treats/human food to entice your cat to eat? Please describe here. *

Does your cat have difficulty chewing or swallowing? Please describe here. *

Has your cat had any weight fluctuations? *

• Yes
• No

Has it become a challenge to maintain your cat’s weight? *

• Yes
• No

Does your cat tolerate exercise and play like before? *

• Yes
• No

Does your cat seem to be slow or painful when rising? *

• Yes
• No

Does your cat seem more sensitive to your grooming or touching over the lower back/hips? *

• Yes
• No

Does your cat wander aimlessly and/or seem disoriented? *

• Yes
• No

Does your cat seem increasingly anxious, fearful, or irritable? *

• Yes
• No

Has your cat exhibited any unusual vocalizations (ie. yowling for no apparent reason)? *

• Yes
• No

Does your cat seem to act “old”? *

• Yes
• No

Does your cat seem to enjoy life as much as before? *

• Yes
• No

If your cat has had any behavior changes since his/her last visit, please describe here.

If you have any questions or concerns you would like to discuss with the doctor during your visit, please list them here.

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