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


FIV and FeLV Observation Form

About Your Cat:




Is your cat neutered/spayed?

Geographic Location:



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 __
Gingivitis (red, swollen gums) __
Pale gums
Mouth sores __
Enlarged lymph nodes
This form was developed by the American Association of Feline Practitioners.

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