Poison Questionnaire for Cats Name* Patient Name Last Name Date* MM slash DD slash YYYY Poison Questionnaire for CatsSEIZURESAre any of these items present in your house/yard? Please check all that apply. Permethrin (canine flea products) Fluoroquinolone antibiotics Diphenhydramine Amitriptyline (in many antidepressants) Mirtazapine(Remeron) Ibuprofen Tea Tree Oil Alpha Lipoic Acid (found in supplements Minoxidil (Loniten or Rogaine) Acetaminophen Ivermectin/Moxidectin (canine heartworm products Baclofen (Lioresal) Bromethalin (rodenticides) Aspirin
