Cat Risk Assessment Form Client InformationClient NameEmail addressClient AddressPhoneRisk AssessmentCat's NameCat's AgeNumber of cats in householdDoes your cat go outdoors?YesNoIf so, is the cat supervised while outdoors?YesNoDoes your cat come into contact with other cats' environments, including stray animals?YesNoIs there wildlife in your area, including mice, squirrels, birds, possums, racoons, skunks or deer?YesNoHave you found ticks on your pets or are there ticks in your area?YesNoDo you travel with your cat to areas where ticks or mosquitoes may be present?YesNoIf you do, do you travel through the Southeastern U.S.?YesNoHave all cats in the household been tested for Feline Leukemia?YesNoHave all cats in the household been tested for Feline Immunodeficiency Virus (FIV)? *YesNoDid any cats test positive for either virus?YesNoDoes your cat sleep with you or your children?YesNoDo you plan to acquire another cat in the future?YesNoDo you work with or handle stray or unvaccinated cats?YesNoDo you ever take your cat to a groomer, boarding facility, pet store or shows?YesNoDoes this cat get into fights with other cats or has he/she had a bite wound abscess?YesNoIs your pet spayed or neutered?YesNoAre there mosquitoes in your area?YesNoDo you live near water?YesNoIs your cat on monthly heartworm preventative?YesNoIs anyone in your household immuno-compromised?YesNo
