Annual Health Survey

 

Please complete this form. Click on Submit when ready to send. Taking the time to return this form, allows me to keep accurate health records, and work constantly towards improving the health and temperament of cats in my breeding program. THANK YOU!

 1) Name 

2) Email Address 

3) Postal Address 

4) Home Phone Number 

5) Cell Phone 

6) Your Veterinarians Name 

7) Name of Veterinary Clinic 

     Address of Veterinary Clinic   Phone Number 

8)  Cats pet name 

9)  Cats Registered Name 

10)  How would you describe your cat's personality?
      Total Extrovert     Generally Friendly   Friendly with people s/he knows   Timid 
      Comments 

11) How would you describe his/her adult coat?
     Suede   Patchy   Woollen   Wavy 
     Comments 

11) Does your cat wander?
     Belongs to the neighbourhood   Has a large territory   Sticks close to home    Prefers to stay inside 
     Comments 

12) Does your cat mark his/her territory
     Never   Outside only     Inside occasionally    Inside when stressed 
    Comments 

13) If your cats marks territory, have you sought treatment?  Yes   No 

14) What treatment have you tried?

15) Has the treatment helped the behaviour?  Yes   No 

16) Has your cat maintained good health Yes    No 

17) Has s/he suffered from any skin complaints? Yes   No 
     Describe the rash, colour, area affected, amount of distress 
     Did it require treatment? 
     How successful was the treatment? Not at all   Minimally   Excellent 
 

18) Has s/he ever developed a cough? Yes   No 
      Comments 
        Did it require treatment? 

19) Has s/he ever been diagnosed with a heart murmur? Yes   No 
     Details 

20) Has s/he ever developed a limp Yes   No 
     Details 

21) Has s/he ever suffered from an upper respiratory infection Yes   No 
     Details 

22) Has s/he ever suffered from an eye infection Yes   No 
     Details 

23)Has your cat ever suffered from a urinary problem? Yes  No 
     Urinary Infection   Bladder stones  Haematuria   Other 
    Comments 

24) Has your cat ever suffered from bad breath/teeth? Yes  No 
      Has s/he required treatment for this Yes    No 
      Was the cause Bad Teeth  Gingivitis Other 
      Details 

25) Are there any health or behavior issues not mentioned you feel I need to know about?

26) Do you have any suggestions to improve this form and feedback?

Thank you very much for making the time to complete this form.
 

 
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