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Feline Patient TCVM History
Client Full Name
*
Owner Phone
*
Pet Name
*
Pet Species
*
Pet Breed
*
Pet Sex
*
Pet Birthdate
Weight
Is your cat on flea and tick preventative?
*
A
Yes
B
No
Which one?
A
Frontline
B
Frontline Plus
C
Advantage
D
Other
Please list your major concerns/complaints regarding your cat’s health in order of their importance. Describe your concerns in detail and be sure to include the approximate date when each problem began.
*
What medical problems or surgeries has your cat experienced in the past?
*
If your cat is on any medications or supplements please list them:
Please answer the following as they apply to your cat.
Prefers
*
A
Shady or cool locations (concrete/tile)
B
Sun or warm locations (carpet)
Personality
*
A
Hyperactive/outgoing/confident/strong
B
Quiet/Timid/Less Confident
Appetite
*
A
Ravenous or Good
B
Good or finicky
Thirst
*
A
Normal
B
Thirsty
C
Less Thirsty
Feces
*
A
Normal
B
Dry, Bloody or malodorous
C
Loose or diarrhea
Diet: What is your cat’s diet?
*
Which choice best describes your cats: choose one in each category
Interactions with people
*
A
Aggressive or bossy
B
Very Friendly
C
Okay with Everyone
D
OK, Aloof (confident)
E
Timid (hides)
Greeting Strangers
*
A
Hides
B
greets warmly
C
slow reaction
D
does not care
E
runs away
Patience
*
A
Yes
B
No
Excitability
*
A
No
B
Slow
C
Easily
D
Yes
In General
*
A
Irritable
B
Vocal
C
Mellow, Laid back
D
Follows the Rules
E
Insecure
When sleeping does your cat (if yes please explain in the box below)
*
A
vocalize or wake you up at night
B
experience muscle jerking while asleep
C
neither
Does your cat sleep
*
A
too much
B
too little
Does your cat have stiffness?
*
A
Yes
B
No
What is your cat’s response to massage?
*
A
Likes
B
Dislikes
C
Neither
From the list, mark all that apply to this patient:
lively
communicative
very friendly
affectionate
loves to be petted
center of the party
insomnia
separation anxiety
restless
excess heat
rapid heart rate
heart problems
decisive
assertive
confident
strong
impulsive
athletic-stamina
alpha animal
ligament problems
liver problems
red eyes
angers easily
ear problems
nail problems
footpad problems
anal sac issues
careful
curious
self contained
likes to hide
meditative
slow and consistent
rear weakness
fearful
bone and back issues
urinary problems
disturbed growth
deafness
reproductive problems
relaxed, laid back
sociable
round and large
loyal
serene and balanced
cares for others (Motherly)
diarrhea
constipation
loss of appetite
vomits
gum disease
weak muscles
overeats-obese
worries
loves order
obeys the rules
aloof
symmetrical body
disciplined attitude
good haircoat
asthma
dry skin
sinus problems
nose problems
cough
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