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 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 913-829-1920