919-351-9292 | hello@atriumcathospital.com

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Wellness Visit Form

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

Wellness Visit Form

So that we can prepare for your arrival, please complete and submit this form before your scheduled appointment time.

Printable Version

Name *

First

Last

Email

Cat's Name *

What are your goals for this visit? *

Changes in Health & Behavior

Change in thirst?

Increased
No change
Decreased

Change in weight?

Increased
No change
Decreased

Change in appetite?

Increased
No change
Decreased

Change in activity level?

Increased
No change
Decreased

Change in urination?

Increased
No change
Decreased

Difficulty urinating?

Yes
No
Not Sure

Difficulty having a bowel movement?

Yes
No
Not Sure

Diarrhea?

Yes
No
Not Sure

Vomiting (including hairballs)?

Yes
No
Not Sure

Mouth & Gums

Change in the odor of the breath?

Yes
No
Not Sure

Change in the appearance of the teeth?

Yes
No
Not Sure

Respiratory

Coughing or change in breathing?

Yes
No
Not Sure

Congestion or discharge from nose/eyes?

Yes
No
Not Sure

Eyes & Ears

Changes that may suggest poorer eyesight?

Yes
No
Not Sure

Changes that may suggest poorer hearing?

Yes
No
Not Sure

Muscles & Joints

Lameness or stiffness?

Yes
No
Not Sure

Difficulty getting in/out of the litter box?

Yes
No
Not Sure

Difficulty jumping?

Yes
No
Not Sure

Difficulty going up or down stairs?

Yes
No
Not Sure

Skin & Fur

Lumps or bumps you have noticed on the skin?

Yes
No
Not Sure

Change in your cat’s coat?

Yes
No
Not Sure

Change in your cat’s grooming behavior?

Yes
No
Not Sure

Behavioral

Hiding or withdrawal?

Yes
No
Not Sure

Clinging/seeking more attention?

Yes
No
Not Sure

Sleeping more?

Yes
No
Not Sure

Urinating or defecating outside of litter box?

Yes
No
Not Sure

Confusion or disorientation?

Yes
No
Not Sure

Anxiety, fear, phobias or aggression?

Yes
No
Not Sure

Please add details for any abnormalities noted above.

Refills: Will you need refills of any prescriptions at the time of your visit?

Yes
No

Signature *

Date *

Your Cat-Only Vet in Cary, NC

GET IN TOUCH:

hello@atriumcathospital.com
919-351-9292
301 Keisler Dr Suite E
Cary, NC 27518
Get directions

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HOURS:

Monday, Tuesday: 8 a.m. – 5 p.m.
Wednesday: Closed
Thursday, Friday: 8 a.m. – 5 p.m.
Saturday: Closed
Sunday: Closed

CONTACT US

Have a question? Contact us and someone from our office will contact you as soon as possible.

Conveniently located across from Wake Med Hospital in Cary.

At Atrium Cat Hospital, we’re on a mission to elevate the entire veterinary experience by putting your cat’s comfort first.

Name *

First

Last

Cat's Name *

Layout

Email *

Phone *

Your question/request: *

If other please specify: *

Additional Information

Appointment Request

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Regular checkups

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