ARLINGTON CAT CLINIC – VOMITING HISTORY FORM

1
Today's Date
Owner's Name
Last Name
Patient Name
2
Email
When did your cat begin vomiting?
How frequent does your cat vomit?
Better
Worse
No Change
Is the vomiting getting
Does your cat go outside your house?
Outside your yard?
3
Does your cat have access to garbage cans,either within your house or outside your yard?
Does your cat have toys that it plays with that could have been swallowed?
Does your cat have access to sewing materials,such as thread or needles, rubber bands, or strings?
Do you have other pets that live with this one?
Is that pet vomiting?
4
Is your cat still eating?
How much?
If no, how long has it been since your cat ate?
5
When does your cat vomit in relation to eating
unknown
immediately
5-15 minutes later
15-30 minutes later
30-60 minutes later
1-2 hours later
2-5 hours later
more than 5 hours later
6
What does the vomit look like
Pile of undigested food
Tube of undigested food
Partially digested food
Contains bright blood
White foam
Yellow liquid
Watery
If other, please describe
7
Does your cat do any retching, heaving, or makenoise before vomiting?
Is vomiting more frequent with certain diets or flavors of food?
Is your cat currently on any medication?
Has it helped?
Increased
Decreased
The same
Is your cat's water consumption
Should be Empty: