Wellness / Annual Exam

Caretaker Information
Name*
First Last
Cat's Name*
First
Phone*
Please check situations that apply
- Our address and contact information have changed since our last visit
- There are young children or immune-compromised individuals in the household
Main reason for today's visit
Any specific concerns you wish to discuss with the doctor?
Do you need your cat's nails trimmed today?
- Yes
- No
Patient Information
Pet Insurance
- Yes
- No
If so please indicate who your insurance provider is:
Diet*
- Dry kibble
- Wet/canned
- Raw food
- Home cooked food
- Treats
- Other
Please select all that apply
Please list the brands and quantity/frequency your cat is fed of each food type
Does you cat currently take any medications or supplements?*
- Yes
- No
Please list any prescriptions or supplements your cat currently takes in the box below, with the dosage and frequency of administration. Skip if your cat is not on any medication
Does your cat take parasite prevention products (such as Revolution)*
- Yes
- No
Please list any parasite prevention products your cat currently takes in the box below. Skip if your cat is not on any parasite prevention products.
Does your cat have known allergies or adverse reactions to any medication or vaccine?
- Yes
- No
Will you need a prescription refilled today?
- Yes
- No
If so, please indicate what you need refilled:
Patient Symptoms
Have you observed the following symptoms in your cat at home?*
- Vomiting
- Diarrhea/Constipation
- Coughing/Sneezing
- Changes in drinking
- Changes in appetite
- Changes in weight
- Changes in Mobility (Hesitation to jump, reduce activity, limping, etc.)
- No changes
Please select all that apply
Please provide details for the symptoms you selected in the box below, including when they started and how frequently they occur.
Does your cat have any unpleasant behaviours that you want to discuss today? If so please provide details below:
Does your cat use the litter box consistently? If not please describe below:
Environment
- Strictly indoors (never leaves home except in a carrier)
- Mostly indoors (escapes occasionally, access to patio, goes on walks with owner, etc.)
- Access outdoors (patio, fenced in backyard, closely supervised, etc)
- Free-roaming outdoors (Supervised or not)
- Another household pet has access to the outdoors
- May travel to another location (family, friends, cottage, cat-sitter, boarding facility)
- My cat has caught prey ( Mouse, vole, bird, bat, etc.) in the last year
Please select all that apply
Does your cat live or come in contact with other pets?
- Yes
- No
If yes, please list the other pets below. Please indicate species and age:
AI Consent
We currently use AI to record conversations during exams for the purpose of medical record transcription. Do you consent to your visit being recorded?*
- Yes
- No

Have a Question? Need to book an appointment?

Contact Us

15 Surrey St W
Guelph, ON N1H 3R3

info@guelphcat.com

519-821-2287

Hours of Operation

Monday-Friday:
8am – 6pm

Saturday:
9am – 2pm

Sunday:
Closed

Wellness / Annual Exam

Caretaker Information

Patient Information

Patient Symptoms

AI Consent

Have a Question? Need to book an appointment?

Contact Us

Hours of Operation