563-285-7891 frontdesk@risiusfamilyvet.com

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Cat Wellness Annual History Form

How This Works:

Save time by filling out this history form before your appointment!

Please provide as much information as you can to help our veterinary staff give your pet the best care!

Please contact us with any questions:

Phone: 563-285-7891

frontdesk@risiusfamilyvet.com

Wellness (Annual Visit) - Cat

Your name*
Pet Information
Please fill out one form per pet, or indicate where differences lie between pets!
Pet's Name*
General Medical Questions
Do you have any medical or behavioral concerns for your cat today?*
Please include concerns about appetite, vomiting, stool, urination, behavior, skin, etc.
- Yes - I have things to discuss
- No - My cat seems pretty healthy
If yes above, please provide details:
How long has the concern been going on? What have you tried at home? Is it better/worse/same?
About your pet's water consumption and urination, is it:*
Please provide any comments in the "Other" line
- Normal
- Increased
- Decreased
Does your cat ever vomit food, hair, or phlegm?*
- Yes
- No
If yes above, how often is the vomiting?
Does your pet take any medications or on any supplements? If yes, what?*
Anything else we should know?
Dietary Information
What do you feed your pet?*
Please include brand and type of food, canned or dry, quantity fed, and frequency fed. IE: Purina Indoor Dry 1/4 cup twice daily, or Fancy Feast Classics, 1 can twice daily.
Do you have separate food and water bowls for each cat in your home?*
- Yes, I have bowls for each cat
- No, I do not do this
- I have food/water on each floor, but not per cat
- Tell me more about this, please
Does your cat get any treats? If yes, what and how often?*
Include commercial, home-prepared treat, or table/human food here.
Has your cat had any recent changes in appetite?*
- Yes - Increased
- Yes - Decreased
- No
Household Management
How many cats are in your household?*
How many litter boxes are in your home?*
Where are the litter boxes located in your home?*
Is there one box per floor? All in the basement? All in closets or bathrooms? Tell us more about box placement, please.
What type of litter do you use?*
How often are the boxes scooped (if clumping litter)? How often are the boxes thoroughly cleaned?
Do you ever see your cats sleeping next to each other or grooming each other?*
- Yes
- No
Do you ever notice stray cats or wildlife outside? Can your cat(s) see them?*
- Nope
- Sometimes
Dental Questions
Have you noticed bad breath, drooling, or trouble eating?*
- Yes
- No
What, if any, at-home dental care do you do you at home?*
Include dental treats & frequency done/given.
Infectious Disease Risk
How much time does your cat spend outside?*
Does your cat come into contact with other cats (boarding, grooming, outside, etc.)?*
Do you travel with your cat? If yes, where and how often?*
Misc Info
Is your cat on monthly flea & tick prevention?*
If yes, what kind? When was the last dose?
Do you need refills on any medication or prevention today?*
Anything else we should know in regards to your cat's health or history?

Your Name*
Pet Information
Please fill out one form per pet, or indicate where differences lie between pets!
Pet's Name*
Do you have any medical or behavioral concerns for your pet today?*
Please include concerns about appetite, vomiting, stool, urination, skin, ears, or behavior.
- Yes - I have things to discuss
- No - My dog seems pretty healthy
If yes above, please provide details:
How long has the concern been going on? What have you tried at home? Is it better/worse/same?
About your pet's water consumption and urination, is it:*
Please provide any comments in the "Other" line
- Normal
- Increased
- Decreased
Does your pet take any medications or supplements? What are they?*
Anything else you want us to know?
Diet
What do you feed your pet?*
Please include brand and type of food (IE Science Diet Light Chicken/Rice), canned or dry, quantity fed, and frequency.
Does Your Pet Receive Treats?*
Please give details about treats in the "Other" field (what / how much / how often)
- Yes
- No
Does your pet get "people food"?*
We're not out to shame you, it's important for history purposes. Please include details (what/qty/frequency) about people treats in the "Other" field.
- Yes
- No
Has your pet had any recent changes in appetite?*
Dental History
Have you noticed any problems with bad breath or problems eating?*
What at-home dental care is done?*
Please include details about brushing (if you do, how often), dental treats used, oral rinses used, etc.
Infectious Disease Risk
How Much Time Does Your Pet Spend Outdoors?*
- Only out to use the bathroom
- Less than 2 hours
- Half the day
- Inside at night only
- My pet is an outdoor pet
Do you ever see wildlife or stray animals in your yard?*
- Yes
- No
Does your dog come into contact with other dogs (dog park, boarding, grooming, daycare, walks, etc)?*
If yes, please indicate how in the "Other" section
- Yes
- No
Does your dog spend any time in wooded or grassy areas?*
- Yes
- No
Have You Ever Seen A Tick On Your Pet In The Last 12 Months?*
- Yes
- No
Do You Travel With Your Pet?*
- Yes
- No
If yes, where and how often?
General Medical Information
Is Your Pet Allergic To Anything?*
- Yes
- No
If Yes, Please List Your Pet's Allergies Below:
When was your pet's last dose of Heartworm Prevention given?*
What kind of heartworm prevention do you use? Do you need a refill today?*
When was your pet's last dose of flea & tick prevention given?*
What kind of flea/tick prevention do you use? Do you need a refill today?*
Do You Need Refills On Any Prescriptions Today?*
- Yes
- No
If Yes, Please Provide Name(s) to Preventative And/Or Prescription:
Anything else you want us to know about anything?

Our Hours

Monday: 8:00 AM - 7:00 PM
Tuesday: 8:00AM - 7:00PM
Wednesday: 8:00AM - 5:00PM
Thursday: 8:00AM - 5:00PM
Friday: 8:00AM - 5:00PM
Saturday: 8:00AM - Noon
Sunday Closed

Contact Us!

Phone :: (563) 285-7891
Fax :: (563) 285-7838
frontdesk@risiusfamilyvet.com

112 E. LeClaire Rd.
Eldridge, IA 52748

Risius Veterinary Service

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