Exam Questions Form - Cheshire Cat Feline Health Center - San Diego, CA

Cheshire Cat Feline Health Center

4680 Clairemont Mesa Blvd.
San Diego, CA 92117



Exam Questionnaire

If you already have an appointment please fill out this form, if you do not have an appointment please call to make one at 858-483-1573.

Exam Questions Form

First Name
Last Name
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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