Cat Care Sedation/Anesthesia Check InName First Last UntitledProcedure Date MM slash DD slash YYYY Best Phone #Vehicle Make & Color: *Nails trimmed on admission* Is your cat: (circle one) Indoor Outdoor BothPlease explain (walks on leash, covered porch, roams free, etc):Microchipped? Yes NoIf no, would you like a microchip today? Yes NoReason(s) for visit: Dental Procedure Spay Neuter Sedated Groom Mass Removal Additional proceduresLocation of mass(es):Additional proceduresDate & time of last meal:Feeding InformationBrand of foodCan or dry?How much?How often? Add RemoveDaily and monthly medications: (Please include flea/tick medication, nutritional supplements, etc):Medication Name & StrengthDosing InstructionsLast Given Add RemoveAre there any concerns that need addressing prior to sedation?Do you need to purchase or pick up food or prescriptions or supplies while at Cat Care? Yes NoPlease list what we can get you today:Owner's SignatureDate MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.
