Clinical Animal Nutrition for Cats

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Patient Name

Group One – Sympethetic

Put a number in the box in front of the symptom only that applies to your cat. 1 = mild, 2 = moderate, 3 = severe. LEAVE BLANK if it does not apply.

Dry mouth, eyes, nose

Please enter a number from 1 to 3.

Keyed up, unable to relax

Please enter a number from 1 to 3.

Fur loss on tail, legs, tummy

Please enter a number from 1 to 3.

Excessive grooming

Please enter a number from 1 to 3.

Vomits with excitement

Please enter a number from 1 to 3.

Tends toward aggression or anxiety

Please enter a number from 1 to 3.

Hides a lot

Please enter a number from 1 to 3.

Prowls day and night

Please enter a number from 1 to 3.

Skin sores, lesions

Please enter a number from 1 to 3.

Vomits, nervous stomach

Please enter a number from 1 to 3.

Sheds a lot, especially when excited

Please enter a number from 1 to 3.

Obsessive compulsive behavior

Please enter a number from 1 to 3.

Group One Total

Total of number marked

Group One Percentage

Number divided by 36

Group Two – Parasympathetic

Put a number in the box in front of the symptom only that applies to your cat. 1 = mild, 2 = moderate, 3 = severe. LEAVE BLANK if it does not apply.

Joint stiffness with rising

Please enter a number from 1 to 3.

Always seems hungry

Please enter a number from 1 to 3.

Lazy, Slow starter, slow mover

Please enter a number from 1 to 3.

Subject to infections

Please enter a number from 1 to 3.

Eyes or nose watery

Please enter a number from 1 to 3.

Overweight

Please enter a number from 1 to 3.

Poor circulation, sensitive to cold

Please enter a number from 1 to 3.

Constipation, diarrhea, alternating

Please enter a number from 1 to 3.

Sleeps more than used to

Please enter a number from 1 to 3.

Group Two Total

Group Two Percentage

Group Three – Carbohydrate Metabolism, Sugar Handling

Put a number in the box in front of the symptom only that applies to your cat. 1 = mild, 2 = moderate, 3 = severe. LEAVE BLANK if it does not apply.

Trembles, episodes of weakness

Please enter a number from 1 to 3.

Seizures

Please enter a number from 1 to 3.

Disoriented at times

Please enter a number from 1 to 3.

Difficulty walking straight

Please enter a number from 1 to 3.

Wheat, corn, rice, barley, oats in diet

Please enter a number from 1 to 3.

Urinating large amounts

Please enter a number from 1 to 3.

Hungry often, eats fast

Please enter a number from 1 to 3.

Change in appearance of eyes

Please enter a number from 1 to 3.

Weight loss

Please enter a number from 1 to 3.

Walks low in rear

Please enter a number from 1 to 3.

Belly distended but thin along back

Please enter a number from 1 to 3.

Behavior changes

Please enter a number from 1 to 3.

Increased water consumption

Please enter a number from 1 to 3.

Overweight

Please enter a number from 1 to 3.

Body sagging in middle

Please enter a number from 1 to 3.

Group Three Total

Group Three Percentage

Group Four – Circulation

Put a number in the box in front of the symptom only that applies to your cat. 1 = mild, 2 = moderate, 3 = severe. LEAVE BLANK if it does not apply.

Exercise intolerance, lethargy

Please enter a number from 1 to 3.

Significant loss of muscle mass

Please enter a number from 1 to 3.

Short rapid breathing, open mouth

Please enter a number from 1 to 3.

Weight loss

Please enter a number from 1 to 3.

Coughing

Please enter a number from 1 to 3.

Seems disoriented at times

Please enter a number from 1 to 3.

Vomiting

Please enter a number from 1 to 3.

Enlarged heart

Please enter a number from 1 to 3.

Weak in rear legs

Please enter a number from 1 to 3.

Difficulty breathing, wheezing

Please enter a number from 1 to 3.

Cold rear legs

Please enter a number from 1 to 3.

Poor appetite

Please enter a number from 1 to 3.

Group Four Total

Group Four Percentage

Group Five – Hepatic, Gall Bladder

Put a number in the box in front of the symptom only that applies to your cat. 1 = mild, 2 = moderate, 3 = severe. LEAVE BLANK if it does not apply.

On meds over long time

Please enter a number from 1 to 3.

Stool watery or diarrhea

Please enter a number from 1 to 3.

Appears bloated

Please enter a number from 1 to 3.

Obese

Please enter a number from 1 to 3.

Recent or rapid weight loss

Please enter a number from 1 to 3.

Sporadic vomit/diarrhea

Please enter a number from 1 to 3.

Lethargic

Please enter a number from 1 to 3.

Subject to allergies

Please enter a number from 1 to 3.

Seizures, tremors

Please enter a number from 1 to 3.

Change in appetite

Please enter a number from 1 to 3.

Food sensitivities

Please enter a number from 1 to 3.

Anal Sac problems, Scooting

Please enter a number from 1 to 3.

Recent stressful event

Please enter a number from 1 to 3.

Green / dark stool

Please enter a number from 1 to 3.

Stands with back arched

Please enter a number from 1 to 3.

Elevated cholesterol, triglycerides

Please enter a number from 1 to 3.

Elevated liver enzymes, lipase

Please enter a number from 1 to 3.

Ocular discharge

Please enter a number from 1 to 3.

Rubs at ears or face

Please enter a number from 1 to 3.

Increased salivation

Please enter a number from 1 to 3.

Restless

Please enter a number from 1 to 3.

Group Five Total

Group Five Percentage

Group Six – Digestion

Put a number in the box in front of the symptom only that applies to your cat. 1 = mild, 2 = moderate, 3 = severe. LEAVE BLANK if it does not apply.

Picky eater or episodes or anorexia

Please enter a number from 1 to 3.

Halitosis

Please enter a number from 1 to 3.

Subject to allergies

Please enter a number from 1 to 3.

Sensitive stomach

Please enter a number from 1 to 3.

History of pancreatitis

Please enter a number from 1 to 3.

Recurrent diarrhea

Please enter a number from 1 to 3.

Sores in mouth or on lips

Please enter a number from 1 to 3.

Vomits fur balls

Please enter a number from 1 to 3.

Intermittent vomiting

Please enter a number from 1 to 3.

Excessive or chronic eye drainage

Please enter a number from 1 to 3.

Poor coat, sheds a lot

Please enter a number from 1 to 3.

Recent intestinal parasites

Please enter a number from 1 to 3.

Group Six Total

Group Six Percentage

Group Seven – Endocrine

Put a number in the box in front of the symptom only that applies to your cat. 1 = mild, 2 = moderate, 3 = severe. LEAVE BLANK if it does not apply.

More than 10 years old

Please enter a number from 1 to 3.

Weight loss

Please enter a number from 1 to 3.

Warts

Please enter a number from 1 to 3.

Dry, scaly skin

Please enter a number from 1 to 3.

Hungry all the time

Please enter a number from 1 to 3.

Stiff gait Oily, greasy coat

Please enter a number from 1 to 3.

Nervous

Please enter a number from 1 to 3.

Aggressiveness

Please enter a number from 1 to 3.

Spastic movements, restless

Please enter a number from 1 to 3.

Diarrhea or vomiting

Please enter a number from 1 to 3.

Drinking a lot, increased urination

Please enter a number from 1 to 3.

Fast heart rate or pounding chest

Please enter a number from 1 to 3.

Back/neck problems

Please enter a number from 1 to 3.

Up all night, can’t sleep

Please enter a number from 1 to 3.

Looks for cool places to rest

Please enter a number from 1 to 3.

Group Seven Total

Group Seven Percentage

Group Eight – Musculoskeletal (Calcium / Magnesium Metabolism)

Put a number in the box in front of the symptom only that applies to your cat. 1 = mild, 2 = moderate, 3 = severe. LEAVE BLANK if it does not apply.

Senior cat

Please enter a number from 1 to 3.

History of any joint surgery

Please enter a number from 1 to 3.

Back or disc problems

Please enter a number from 1 to 3.

Weak joints, poor muscles

Please enter a number from 1 to 3.

Difficulty getting up and down

Please enter a number from 1 to 3.

Arthritic, degenerative joint disease

Please enter a number from 1 to 3.

Back problems, stiffness

Please enter a number from 1 to 3.

Dental tartar or cavity

Please enter a number from 1 to 3.

Losing muscle tone in legs or back

Please enter a number from 1 to 3.

Stopped or reduced jumping

Please enter a number from 1 to 3.

Walks low to the ground

Please enter a number from 1 to 3.

Difficulty getting into litter box

Please enter a number from 1 to 3.

Group Eight Total

Group Eight Percentage

Group Nine – Renal

Put a number in the box in front of the symptom only that applies to your cat. 1 = mild, 2 = moderate, 3 = severe. LEAVE BLANK if it does not apply.

Abnormal or frequent urination

Please enter a number from 1 to 3.

History of bladder infections

Please enter a number from 1 to 3.

Reduced renal function

Please enter a number from 1 to 3.

High blood calcium or phosphorus

Please enter a number from 1 to 3.

History of bladder stones, crystals

Please enter a number from 1 to 3.

Licking at penis or vulva

Please enter a number from 1 to 3.

Cries when urinating

Please enter a number from 1 to 3.

Can’t get comfortable

Please enter a number from 1 to 3.

Drinking more water

Please enter a number from 1 to 3.

Urinates outside litter box

Please enter a number from 1 to 3.

In and out of litter box

Please enter a number from 1 to 3.

Diet mostly dry food

Please enter a number from 1 to 3.

Group Nine Total

Group Nine Percentage

Group Ten – Immune

Put a number in the box in front of the symptom only that applies to your cat. 1 = mild, 2 = moderate, 3 = severe. LEAVE BLANK if it does not apply.

Sheds, poor fur quality, dandruff

Please enter a number from 1 to 3.

Red bumps to skin

Please enter a number from 1 to 3.

Scabs, sores, crusts to skin or mouth

Please enter a number from 1 to 3.

Frequently on antibiotics

Please enter a number from 1 to 3.

Gets infections easily

Please enter a number from 1 to 3.

Runny eyes

Please enter a number from 1 to 3.

Recurrent sneezing

Please enter a number from 1 to 3.

Ear infections, lesions

Please enter a number from 1 to 3.

Has FELV, FIV, AIDS, or Toxoplasmosis

Please enter a number from 1 to 3.

Is over 12 years old

Please enter a number from 1 to 3.

Frequent infections

Please enter a number from 1 to 3.

Dental infection

Please enter a number from 1 to 3.

Has had cancer

Please enter a number from 1 to 3.

Experienced a vaccine reaction

Please enter a number from 1 to 3.

Lives with 4 or more cats

Please enter a number from 1 to 3.

Group Ten Total

Group Ten Percentage

Group Eleven – Pain

Put a number in the box in front of the symptom only that applies to your cat. 1 = mild, 2 = moderate, 3 = severe. LEAVE BLANK if it does not apply.

Lameness, abnormal gait

Please enter a number from 1 to 3.

Withdrawn, hiding

Please enter a number from 1 to 3.

Reluctant to move

Please enter a number from 1 to 3.

Dislike or intolerance of handling

Please enter a number from 1 to 3.

Overall activity less than normal

Please enter a number from 1 to 3.

Looks depressed

Please enter a number from 1 to 3.

Recent surgery, dental infection

Please enter a number from 1 to 3.

Flicking tail

Please enter a number from 1 to 3.

Change in mood, grumpy

Please enter a number from 1 to 3.

Hunched back or sway back

Please enter a number from 1 to 3.

Groaning, moaning, grunting

Please enter a number from 1 to 3.

Change in appetite & type of food willing to eat

Please enter a number from 1 to 3.

Weeping, red, cloudy or squinting eyes

Please enter a number from 1 to 3.

Shifting weight off area of body

Please enter a number from 1 to 3.

Licking excessively an area of the body

Please enter a number from 1 to 3.

Temperamental, growl at others

Please enter a number from 1 to 3.

Change in toileting habits

Please enter a number from 1 to 3.

Group Eleven Total

Group Eleven Percentage

Totals

Final Total