DIARRHEA QUESTIONAIRE
Age of cat: _____Other cats in household? _______
Other cats in the household with diarrhea?_______
When did diarrhea first start? ( more than 2-3 weeks?) _____Has it stopped and started again? ___________
Have you given any medicine or other treatment for this or any other condition in the last week___________________month?_________
Please describe:______________________________________________
Has any Tylenol been administered? ________________
Diet including any treats and supplements? ___________
_______________________________________________
Is your cat eating normal amounts? Picky eating? Not eating? If not eating, when did he/she last eat? __________________________________
Is his/her energy level normal or decreased? _____________________
Does he/she appear to have lost weight? Y/N
How often does the diarrhea occur? (many, few times, or once per day)?
How much diarrhea is produced? (circle) small, normal, large amount at a time?
Does you cat strain during or after producing diarrhea?_______________
Is he/she using the litter box? __________________________________
How loose is the stool? Please describe:___________________________
Is there: (please circle) blood, mucus, other?_____ in the diarrhea?______