"9-Lives" Checklist

Please place a check mark next to any event your cat has experienced during the past 12 months, the approximate date of the event, and select the appropriate choice in the last columns (worse, same, better) next to any events that affected your cat's disease.

Owner First Name:
Owner Last Name:
Cat's Name:
Date:
During the past 12 months, my cat has experienced Estimated Date Effect on Cat's Disease
Death or departure of a pet family member Calendar Worse Same Better
Death or departure of a human family member Calendar Worse Same Better
Serious hassle in the household (injury, illness, other) Calendar Worse Same Better
New human in the household (spouse, baby, friend, child, other relative) Calendar Worse Same Better
New pet(s) in the household Calendar Worse Same Better
Change in schedule (work, school, travel, vacation, retirement) Calendar Worse Same Better
Visitors (friends, relatives, etc.) Calendar Worse Same Better
Construction around the house (inside or outside) Calendar Worse Same Better
Changes of season Calendar Worse Same Better
Weather changes/Severe storm/Earthquake Calendar Worse Same Better
New house/apartment Calendar Worse Same Better
Frequent loud noises (house/car alarms, neighbors, etc.) Calendar Worse Same Better
Boarding Calendar Worse Same Better
Remodeling Calendar Worse Same Better
Moving/rearranging furniture Calendar Worse Same Better
Neighborhood cats outdoors Calendar Worse Same Better
Exam time (for students) Calendar Worse Same Better
Holidays Calendar Worse Same Better
Change in diet Calendar Worse Same Better
Change in litter Calendar Worse Same Better
Travel (car, train, plane) Calendar Worse Same Better
Other (please describe) Calendar Worse Same Better
How difficult has this problem been for you and your family to deal with?