Feline History Form Owner*Date* Date Format: MM slash DD slash YYYY Pet Name*Breed*ColorAgeSex*MaleMale (Neutered)FemaleFemale (Spayed)About Your CatYour cat was obtained from*BreederPet storeFriendStrayHumane Soc.Your cat is*IndoorOutdoor - free roamingBothNumber of cats in household*Brand of pet food*Canned/DryCannedDryHow is your cat's appetite*NormalHow is your cat's attitude*Happy-Active-NormalDepressed-LethargicIs your cat drinking*NormallyMoreLess than usual.Do you notice any of the following Limping Eye Discharge Nasal discharge Sneezing Coughing Shaking head Scooting Scratching Vomiting Diarrhea Lumps Bad breath often Weight loss Lethargy / weakness Seizures Hair loss Your cat uses the litter boxConsistentlyUsuallyDigs and covers in the litter boxUrinating outside litter boxDefecating outside litter boxDo you notice straining, crying out or pain when using the litter boxYesNoSometimesYour Cat's Medical HistoryPrevious veterinary hospital:May we request your records from their office?*YesNoFirst visit to a veterinarianHas your cat had the following in the last 12 months:Physical examination*YesNoUnsureDate of last exam*Dental examination and cleaning*YesNoUnsureDate of last exam*Feline Leukemia Virus test*YesNoUnsureDate of last exam*Feline Immunosuppressive Virus test*YesNoUnsureDate of last exam*Fecal sample test*YesNoUnsureDate of last exam*Blood testing for thyroid, kidney & liver function*YesNoUnsureDate of last exam*Rabies*YesNoUnsureDate of last vaccination*Feline Distemper*YesNoUnsureDate of last vaccination*Feline Leukemia*YesNoUnsureDate of last vaccination*Has your cat been dewormed in the last 12 months*YesNoUnsureDate*Flea & tick preventative(s)Are you familiar with geriatric care for cats over 7 years of ageYesNoAre you familair with feline heartworm diseaseYesNoCurrent medications and allergiesComments