Cat Care Check-In FormClient Name(Required) First Last Cat Name(s)(Required) Add RemoveVehicle make and color (at visit)(Required)Phone (at visit)(Required)Where does your cat stay(Required) Indoor ONLY Outdoor BothPlease explain IF out on harness/leash, porch, etcReason(s) for visit:(Required) Wellness visit Sick visit Tech visit BoardingProblems observed Behavior changes Ears Eyes Vomitting Diarrhea Constipation Lameness Litter box issues Eating/Drinking Weight Loss/Gain OtherPlease describe problem including when first noticed, if any treatments have been tried, and if it is improving:Please list any medication(s) including dose, strength and last time administered. (Please be sure to include any flea / tick meds, nutritional supplements, etc)Please list any medication(s) : Please be sure to include any flea / tick meds, nutritional supplements,MedicationDoseLast Given Add RemovePlease list all foods:When last fed (or is cat fasted?)Food InformationBrand (including treats)Can and/or dryHow much?How often? Add RemoveDo you give permission for diagnostics (such as bloodwork, urinalysis, or X-Rays?) recommended by the veterinarian?(Required) Yes NoDo you give permission to vaccinate?(Required) Yes NoIs it okay to deworm if needed?(Required) Yes NoDo you give permission to trim nails?(Required) Yes NoDo you need a treatment plan (estimate) for diagnostics or treatment prior to speaking with DVM?(Required) Yes NoDo you need to purchase / pick up food or prescriptions while at Cat Care?(Required) Yes NoFor purchase / pick up food or prescriptions while at Cat Care, please explainExposure to COVID?(Required) Yes NoAppointment Date MM slash DD slash YYYY Appointment TimeCommentsThis field is for validation purposes and should be left unchanged.
