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2311 W. Touhy Avenue, Park Ridge, IL 60068
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Dr. Piotr Warcholek
Dr. Diana Baranska-Hubicki
Dr. Anna Hautzinger
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Your Pet’s Very First Appointment: What to Expect
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Contact Us
Online Store
Home
Services
-Wellness Exams
-Vaccinations
-Dental Care
-Surgery
-Diagnostics
-Nutritional Counseling
-Laser Therapy
-Travel Certificates
-Grooming
-Additional Services
-Emergency
About Us
-Our Doctors
--Dr. Piotr Warcholek
--Dr. Diana Baranska-Hubicki
--Dr. Anna Hautzinger
-Our Staff
-Testimonials
-Photo Gallery
-Community
Client Resources
-Your Pet’s Very First Appointment: What to Expect
-Wellness Plans
-Pet Insurance
-Current Offers
-FAQ for New Pet Owners
Contact Us
Online Pharmacy
847.268.3828
Cat Assessment
Home
/
Cat Assessment
Download & Print
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
Feral Cats
Squirrels
Chipmunks
Skunks
Rodents
Racoons
Deer
Wild Turkeys
Wild Canines (Coyotes/Foxes)
Other
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
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