Patient Information -- Feline Patient #__________________________ (Office use) Patient's Name_____________________________________________ Breed____________________________ Color _____________ Birthdate (approx.) ___________ Sex: Male (   ) Female (   ) Has your cat been spayed or neutered? Yes (   ) No (   ) Please give the approximate age that he/she was spayed or neutered at _______________ Where did you get this cat at? (Breeder, Pet Store, Friend, Humane Society, Newspaper Ad, etc. ) _______________________________ Approximately when did you acquire it? ____________________________ What does this pet get to eat? __________________________________ Does he/she get table foods or treats? _____________________________ Has this kitty ever been tested for Feline Leukemia virus? Yes(   ) No(   ) Result? ____ Has he/she been declawed? Yes (   ) No (   ) Has it ever been tested for FIV? Yes(   ) No(   ) Result? ___ Has this cat ever been vaccinated for: Panleukopenia Yes (   ) No (   ) When__________________ Rhinotracheitis Yes (   ) No (   ) When__________________ Calicivirus Yes (   ) No (   ) When__________________ Clamydia Yes (   ) No (   ) When__________________ Feline Leukemia Yes (   ) No (   ) When__________________ FIP Yes (   ) No (   ) When__________________ Has he/she ever had a stool sample checked for internal parasites? Yes (   ) No (   ) When ____________________ Result_______________________ Does this cat get outdoors?________ How often?_____________________ Do you ever expect it to be an "outdoor" cat?_________________________
Please print out this form, fill in the information, and either bring it along with your pet, or FAX it to 866-866-7558
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