Senior Cat Questionnaire Woody Dudley D.V.M Mitchell Hammock Pet Hospital 255 Alexandria Blvd. Oviedo, FL 32765 (407) 366-7323 • Fax (407) 542-8797 www.drwoody.net Name* Patient Name Last Name Date* MM slash DD slash YYYY SENIOR CAT QUESTIONNAIRESelect issues that apply belowPersonality: Lethargic Hyperactive Depressed Not greeting you Not playing Grooming activity minimized Not enjoying treats Turning aggressive Wool sucking Snappy or grumpy Pain and Discomfort: Declining activity level Trouble keeping balance Trouble getting up Restless Can’t get comfortable Whining or meowing a lot Trouble jumping Stiff legs while walking Stiff legs while running Tail continuously between legs Shaking continuously Heavy continuous panting Mouth pain Hard, dry stool pellets Decrease in bowel movements Problematic Symptoms: Vomiting Diarrhea Blood or mucous in stool Loose stool Continuous discharge in the eyes Rough, Unkept Haircoat Coughing Sneezing “Spraying” randomly Hairballs “Spraying” in specific locations Physical Changes: Cloudy or bloodshot eyes Having vision trouble Bumping into things Disoriented or Confused Not coming when called Not responding to noise Appetite increase Appetite decrease Water consumption increase Water consumption decrease Labored breathing Urinating frequently Lumps and bumps Subtle Changes: Changes in interaction Changes in activity Changes in sleeping habits Changes in food and water consumption Bad Breath Unexplained weight gain Unexplained weight loss Changes in grooming Signs of stress Changes in vocalization Elimination behavior: Inappropriate elimination Has your cat ever urinated or defecated somewhere in the house other than in the litter box? Coments:
