FIV & FeLV Observation Form for Cat Owners
Veterinary & Aquatic Services Department, Drs. Foster & Smith

FIV and FeLV Observation Form

About Your Cat:

Name:

Age:

Sex:

Is your cat neutered/spayed?

Geographic Location:

 

Observations:

How long ago was your last visit to your veterinarian?

Is your cat primarily an indoor cat or an outdoor cat?

Has your cat been vaccinated for FeLV?

Do any of these situations apply to your cat? Please check all that apply:

__
 
Has been outside unsupervised __
 
Was exposed to a cat with unknown FIV/FeLV status
__
 
Was in a fight with another cat __
 
Lives in a household with other cats of unknown FIV/FeLV status
__
 
Lives in a household with a recently adopted cat __
 
Was a stray or obtained from a shelter

Has your cat had any of these signs of illnesses? Please check all that apply:

__
 
Weight Loss __
 
Decreased appetite
__
 
Decreased grooming __
 
Decreased energy or general weakness
__
 
Vomiting __
 
Diarrhea
__
 
Gingivitis (red, swollen gums) __
 
Pale gums
__
 
Mouth sores __
 
Enlarged lymph nodes
__
 
Abscesses    
This form was developed by the American Association of Feline Practitioners.


 

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