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Senior Cat Pre-appointment Survey
Please take some time to complete the following questions before your cat's appointment. This survey is to help your vet fully understand your cat's current health condition.
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Email
*
Your email
Your first and last name:
Your answer
Your cat's name:
Your answer
What is your cat's ability to
jump up?
Normal
Not quite normal
Somewhat worse than normal
Barely, or with great effort
Not at all
Clear selection
What is your cat's ability to
jump up to kitchen-counter height in one try?
Normal
Not quite normal
Somewhat worse than normal
Barely, or with great effort
Not at all
Clear selection
What is your cat's ability to
jump down (how well and how easily)?
Normal
Not quite normal
Somewhat worse than normal
Barely, or with great effort
Not at all
Clear selection
What is your cat's ability to
play with toys and/or chase objects?
Normal
Not quite normal
Somewhat worse than normal
Barely, or with great effort
Not at all
Clear selection
What is your cat's ability to
play and interact with other pets?
Normal
Not quite normal
Somewhat worse than normal
Barely, or with great effort
Not at all
Not applicable (there are no other household pets)
Clear selection
What is your cat's ability to
get up from a resting position?
Normal
Not quite normal
Somewhat worse than normal
Barely, or with great effort
Not at all
Clear selection
What is your cat's ability to
lie and/or sit down?
Normal
Not quite normal
Somewhat worse than normal
Barely, or with great effort
Not at all
Clear selection
What is your cat's ability to
stretch?
Normal
Not quite normal
Somewhat worse than normal
Barely, or with great effort
Not at all
Clear selection
What is your cat's ability to
groom themself?
Normal
Not quite normal
Somewhat worse than normal
Barely, or with great effort
Not at all
Clear selection
How often does your cat
vomit or bring up hairballs?
Never
Less than once a month
Monthly
Weekly
Multiple times a week or daily
Clear selection
Is your cat
restless, unsettled or vocal at night?
Yes
Occasionally
No
Clear selection
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