Cat Home Pain Assessment Form Cat Pain Assessment Form To learn if your kitty could be hiding chronic or acute pain, please check all boxes that apply (even if they only occasionally occur). Once submitted, this form will be reviewed and you will be contacted with the next steps in getting your kitty more comfortable! Name * Name First First Last Last Email * Date * Cat's Name * Cat's Age * Grooming/Hair Coat Greasy, clumped, or dry hair coat Dirty, long, thick or peeling toenails Patches of hair loss Licking, biting, or pulling hair out Self-grooming less Decreased use of scratching pads Resents being touched or brushed in certain parts of the body Activity General activity seems decreased Slowing down with age Decreased interest in or less time spent playing Decreased interaction with humans or other pets Spends most of their time in one place in the house Spends a large amount of time sleeping in a room away from family Sudden episodes of meowing with no apparent reason Sudden episodes of looking at part of body and then licking, pulling hair or biting the area Sudden episodes of running away with no apparent reason Growls or hisses when someone touches them Cries out when moving or when touched Movement Movement seems stiffer and less fluid Chooses to use chairs/stools etc to jump on or off high surfaces Suddenly sitting down when walking, playing, or using stairs Navigates stairs slowly Asks to be picked up instead of jumping on your lap Hesitates or takes several tries before jumping on a surface Bunny hop using either both hind or both front legs together to go up or down stairs Limping (any amount or severity) Bodily Functions Changes in food and water intake Picky about food types Misuse of litter box - urinating or defecating near but not in litter box at times Has bowel movements less than once daily Has hard, small, or dry bowel movements Vomits more than once monthly If you see a movement or change in your cat’s behavior that you are unsure about, please upload up to 3 videos here. Drop a file here or click to upload Choose File Maximum file size: 52.43MB Captcha Submit If you are human, leave this field blank.
