Patient Information - Feline

Patient #__________________________ (Office use)
Patient's Name___________________________________________________________

Breed_____________________________ Color _______________________ 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 Pos(   ) Neg(   )

Has he/she been declawed? Yes (   ) No (   )

Has it ever been tested for FIV? Yes(   ) No(   ) Result Pos(   ) Neg(   )

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?_________________________

Is there any unusual medical history that we should know about?_____________________

_____________________________________________________________________________________

Does he/she ever go to cat shows, or do you expect it to? Yes(   ) No(   )

Please print out this form, fill in the information, and either bring it along with your pet, or FAX it to 913-829-1920