VBS Feline Recheck Form

Behavior History
How do you feel your cat has progressed since the last appointment?*
Have there been any changes in the frequency or exhibition of the behavior problem?*
Are there any new behavior problems you would like to address?:*
Have there been changes in frequency or exhibition of the behavior problem?*
Medical History
Please describe any previous or current medical problems of the cat:*
Is your cat currently on any medications or special diet?*

NoYes
Please list all (include heartworm prevention and flea medications):*
Please list all vaccines given within the last year) including dates given):*

Your Cat's Environment

Please describe all the people living in the household now, starting with yourself:
Please describe all the people living in the household now, starting with yourself:
Diet and Feeding

Feeding
Type of food consumed*

CannedMoistDryHuman Food
Brand of Food*
Supplements / Snacks?*
Has there been a recent diet change?*

YesNo
If you answered "yes" to the above question what food type and brand were you feeding before the one listed above and when did you make the change?*
Water
Where is the water bowl located?*
Water Intake:*

NormalExcessivePoor

Your Cat's Daily Routine

Sleeping
Where does your cat sleep?*
How many hours does your cat sleep during the day?
Daytime
Where is the cat typically during the day?*
Exercise
What type of exercise does your cat engage in?*
What types of toys do you provide for your cat? Please be specific:*
What types of activities do you engage in with your cat? Please be specific:*
What rewards work best for your cat?

food treatsattentionpettingplaytoys
Other Animals
Do you have (or have you had at any point during the last year) any other animals in the home?

YesNo
List all animals in the household in the order they were acquired, including pets who have died within the last year:

Elimination Behavior

***Please complete the remainder of this form if your cat is eliminating in areas other than the litter box. Otherwise, you have completed the history form and may scroll down to the submit button and submit the form. Thank you!**
Please answer the following regarding all litter boxes. Please use the comment section if necessary to add more litter boxes:
Type of litter box
Box #1*

CoveredUncovered
Box #2

CoveredUncovered
Box #3

CoveredUncovered
Box #4

CoveredUncovered
Comments:
Size of litter box (please measure in inches)
Box #1*
Box #2
Box #3
Box #4
Comments
How old is this litter box?
Box #1*
Box #2
Box #3
Box #4
Comments
Location
Box #1*
Box #2
Box #3
Box #4
Comments
Type of litter used (clumping, crystal, wheat, etc)
Box #1*
Box #2
Box #3
Box #4
Comments
Brand of litter used
Box #1*
Box #2
Box #3
Box #4
Comments
Depth of Litter (list in inches)
Box #1*
Box #2
Box #3
Box #4
Comments
Is a liner used?
Box #1*
Box #2
Box #3
Box #4
Comments
Is anything added to the litter (if so, what)?
Box #1*
Box #2
Box #3
Box #4
Comments
How often is the box scooped?
Box #1*
Box #2
Box #3
Box #4
Comments
How often is the litter completely changed?
Box #1*
Box #2
Box #3
Box #4
Comments
How often is the litter box washed?
Box #1*
Box #2
Box #3
Box #4
Comments
What products are used to wash the litter box?
Box #1*
Box #2
Box #3
Box #4
Comments
Is the box located near noisy appliances? (If so, list appliance)
Box #1*
Box #2
Box #3
Box #4
Comments
Located near doors or hallways? (If so, where)
Box #1*
Box #2
Box #3
Box #4
Comments
Are airvents nearby?
Box #1*
Box #2
Box #3
Box #4
Comments
Distance in inches from food and water bowl
Box #1*
Box #2
Box #3
Box #4
Comments

Using your trackpad or mouse please draw a map of your household indicating where litter boxes are located, where the cat has sprayed, urinated or defecated, and where the food and water are located.
Do you have pet insurance for your cat?*

YesNo
If yes, what insurance company?
Should be Empty:

Feline Recheck Form

Please submit this form online at least 2 business days prior to your cat's appointment

Your Contact Information

Your Family Veterinarian's Contact Information

Your Cat's Information

Behavior History

Medical History

Your Cat's Environment

Diet and Feeding

Your Cat's Daily Routine

Other Animals

Elimination Behavior

Please answer the following regarding all litter boxes. Please use the comment section if necessary to add more litter boxes: