Cheshire Cat Feline Health Center

4680 Clairemont Mesa Blvd.
San Diego, CA 92117

(858)483-1573

cheshirecatclinic.com

Exam Questions Form

Name
First Name
Last Name
Phone
Phone TypePhone Number
What is your cat's name?

What is the reason for your visit?

Is you cat Indoor, Outdoor or Both?

What food do you feed your cat? (brand, amount, frequency)

Is your cat eating normal amounts of food?

Do you think your cat is losing weight?

Is your cat drinking excessive water?

Is your cat vomiting? If yes, please describe the frequency and appearance

Is your cat having diarrhea? If yes, please describe the frequency and apperance

Any Sneezing or Coughing? If so please describe

Is your cat using the litter box regularly?

Is your cat urinating and defecating normally? If not please explain

Any other issues or concerns?

Please list any medications you are currently giving (name,strength, amount and how often)

If we need to send home any medications, would you prefer Liquid or Pills?

Is your cat on flea control? If so which kind and the last time applied

Does your cat have a microchip?


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