Cat Assessment - Touhy Animal Hospital

Type of pets in your home*

Dogs
Cats
Other

How many dogs?*

How many cats?*

How many other?*

Travel and Outdoors

How much time does your cat spend outside each day?*

(Hours)

Do you take your cat to any of the following? (check all that apply)*

Boarding
Grooming
Other

Other*

Do you travel with your cat?*

Yes
No

If yes, where do you go?*

Do you take your cat on any outdoor activities?*

Yes
No

Home Environment & Home Care

Do you observe wild animals or other wildlife in your neighborhood? (check all that apply

Other*

Do you or your cat(s) visit homes where there are other pets?*

Yes
No

Do other pets come to visit at your home?*

Yes
No

Does anyone with a compromised immune system live in or visit your house?*

Yes
No

Have you seen evidence of fleas, ticks, or worms in any of your pets or in your home?*

Yes
No

Does your cat us the litterbox?*

Yes
No

Which pets do you treat for fleas, ticks, internal parasites or heartworms?*

Dog(s)
Cat(s)

Please list all of the products, medications, or supplements your cat is using (including flea/tick and heartworm prevention):*

What kind of diet do you feed your cat?*

Do you feed your cat treats?*

Yes
No

If Yes, how many times per day?*

What kind of exercise does your cat get?*

Unusual Behavior

Does your cat scratch or bite at its skin or seem itchy?*

Yes
No

Have you noticed any weight loss or gain?*

Yes
No

Any recent change in your cat’s skin or coat?*

Yes
No

Any recent change in behavior or activity level?*

Yes
No

Any signs of pain such as: slow to get up or down or jump, tremor or weakness in the rear legs, or protecting a certain body part?*

Yes
No

Any recent changes in your cat’s behavior around the litter box?*

Yes
No

If Yes, please describe:*

No call/ no shows will be charged a 25.00 cancellation fee