Vaccination Health Questionnaire

Vaccination Health Check Questionnaire

Please note - we require a separate form for each cat.

* Indicates required field

Name *

First

Last

Email *

Cat's name *

About the appointment:

Have you already arranged a vaccination appointment for your cat? *

Yes No

When is the appointment? *

What would you like us to do during the appointment?

As well as the usual weight check, full health exam and vaccination ( if appropriate) , my cat also requires: *

Nails trimming. ( not recommended for outdoor cats) Other - please specify below.

Please specify any additional requests: *

When was your cat last given a worming treatment? *

Which product did you use? *

Would you like our vet to worm your cat during the consultation? (Charges apply for product only, not the administering!) *

When did your cat last have a flea treatment applied *

Which product did you use? *

Would you like our vet to administer flea treatment during the consultation? (Charges apply for product only, not the administering!) *

Do you require flea and/or worm treatment to go home with after the consultation? *

If you require flea/worm treatment to go home with, please tell us how many you would like. e.g 1 treatment, 1 years supply etc *

Do you have any plans to travel abroad with your cat? *

If your cat's last vaccination was NOT done by The Cat Clinic, please tell us the date of the last vaccination and brand of vaccine used ( this information should be available in your vaccination card) *

Please tell us about your cat:
Understanding your cat's lifestyle and preferences is important for us to be able to make appropriate treatment recommendations.

My cat is: *

My cat's normal diet is: *

Are there any other pets at home? Please specify. *

When I'm on holiday, my cat: *

Please tell us which brands you normally feed your cat *

What treats do you offer your cat? How regularly does he/she get these? *

The health of your cat

Please describe your cat's normal attitude to food: *

How much does your cat drink? *

Has this changed? *

How often does your cat have vomiting or diarrhoea? Please give a brief description. *

Does your cat suffer from itchy skin or ears? Please give a brief description. *

Has your cat's thirst changed? *

How often does your cat cough or sneeze? Please give a brief description. *

Does your cat tend to suffer with runny / sticky eyes or nose? Please give brief description. *

Does your cat show any signs of stiffness / hesitation when jumping / is slow going up or down stairs? Please give a brief description. *

Please provide details of any other concerns or questions you may have with your cat. *

Last but not least.... (I bet you didn't realise quite how many questions your vet typically asks about your cat in a consultation!)

Other than flea and worming treatment, do you give your cat receive any medication or supplements? *

Yes - prescribed by The Cat Clinic. Yes - I give him/her medication or supplements recommended someone else. No.

Please tell us what medication or supplements you give AND when these were last administered *