Anthony Animal Clinic

Feline VetSurvey©

For Use with Veterinary Doctors (Cats)
Restricted to Professional Use


Patient's Name Weight Age
Owner's Name
Owner's E-Mail
Owner's Phone



INSTRUCTIONS:    Use "1" for mild symptoms (seldom occurs), use "2" for moderate symptoms (occurs regularly), and use "3" for severe symptoms (you are aware of it almost constantly).

Group One

 1 Dry mouth-eyes-nose  6 Balding pattern to belly  11 High anxiety
 2 Prowls day and night  7 Fur loss on tail, legs  12 Nervous
 3 Shed a lot, especially when excited  8 Hides a lot  13 Recent change in home: schedule/routine
 4 Unable to relax, jumpy  9 Licking a lot  14 New pet in house
 5 Extremities cold  10 Excessive grooming         

Group Two

 1 Joints stiff after rising  5 Sleeps all the time  9 No activity
 2 Eyes or nose watery  6 Subject to bladder infections  10 No interests
 3 Overweight with little food  7 Lazy         
 4 Constipation, diarrhea, alternating  8 Couch potato         

Group Three

 1 Trembles, episodes of weakness  6 Behavioral changes  11 Does nothing
 2 Seizures  7 Belly distended but thin along back  12 Change in apperance of eye
 3 Disoriented  8 Drinks a lot of water, sits at bowl  13 Weight loss
 4 Difficulty walking straight  9 Body sagging  14 Walks low in rear
 5 Hungary often  10 Frequent urnination  15 Large volume of urine in box

Group Four A

 1 Labored breathing  6 Cold to the touch  11 Weight loss
 2 Weakness  7 Short Rapid Breathing  12 Reduced urination
 3 Lethargy  8 Cold rear legs  13 Weak rear legs
 4 Mental dullness  9 Vomiting         
 5 Not interested in food  10 Sporadic diarrhea         

Group Four B

 1 Shifts position frequently  5 Increased salivation  9 Open mouth breathing
 2 Nasal discharge  6 Chronic spasm/cough  10 Clawing at face
 3 Audible sinus congestion  7 Gag to vomit         
 4 Expiratory effort  8 Panting         

Group Five

 1 Obese cat  6 Intermittent and sporadic vomiting/diahrrea  11 Tender abdomen
 2 Sporadic illness that comes and goes  7 Tremors  12 Frequent vomiting
 3 Recent stressful event  8 Seizures  13 Increased salivation
 4 Depression  9 Recent rapid weight loss  14 Restless
 5 Lethargy  10 Distended abdomen  15 Green/dark stool

Group Six

 1 Frequent urination  5 Licking at rear a lot  9 Urinating in small amounts
 2 Urinates outside of litter box  6 Pacing  10 Reduced appetite
 3 Drinks more water  7 Crying  11 Recent change in diet
 4 Cannot seem to get comfortable  8 In and out of litter box         

Group Seven

 1 More than ten years old  6 Spastic movements  11 Increased urination volume
 2 Weight loss  7 Diarrhea  12 Pounding chest
 3 Hungry all the time  8 Vomiting  13 Fast heart rate
 4 Nervous  9 Not interested in food         
 5 Aggressiveness  10 Drinking a lot         

Group Eight

 1 Halitosis  5 Rubs at face  9 Cries with movement to head
 2 Difficulty eating dry food  6 Chews to one side  10 Swelling face
 3 Drooling  7 Drops food         
 4 Bleeding from mouth or nose  8 Picky eater         

Group Nine A

 1 Increased shedding  5 Scabs or crusts to skin  9 Areas of changed skin appearance
 2 Coat oily  6 Dandruff  10 Body sores
 3 Itching  7 Body odor  11 Skin crawls
 4 Red bumps to skin  8 Bald areas         

Group Nine B

 1 Fur falls out  4 Rarely itches  7 Smooth skin at bald areas
 2 Dull coat  5 No scratching noticed         
 3 Flaking of skin  6 Excessive shedding         

Questions

Is the cat currently on any medication?    
List Medication:
Any previously diagnosed illnesses?    
List Illness:
Has the cat ever been tested for Heartworm Disease?    

Important

To the owner: Please list the four main physical complaints for this pet in order of their importance.
1.    
2.    
3.    
4.