Feline Pet Health History

Thank you for giving us the opportunity to care for your pet. To help us provide optimal healthcare, please take time to fill out this information.

Client Name(required) Client Email(required) Client Phone(required)

Pet's Name (required)

Birthdate/Age (required) Please Select (required)
ExactEstimated

Breed (required)

Color (required)

Please circle:(required)
Intact FemaleSpayed FemaleIntact MaleNeutered Male

Please Circle how you would best describe your pet’s temperament for examination:(required)
FriendlyNervous/May BitePlease Muzzle/Will Bite

Please fill out the following information to the best of your ability. We can confirm much of this
information from previous records if they are available. If you have any questions about this
information, our veterinary technicians will assist you as they review your pet’s medical history.

Reason for Today’s Visit:

Current Medications/Supplements

Allergies/Allergic reactions

Current Diet

Flea/Tick Preventative

Date of Last Stool Check

Date of Last Deworming

FELV/FIV Status

Date of Last Test

Most recent FVRCP (Feline Distemper) Vaccination Date

Most recent FELV Vaccination Date (if applicable)

Most recent Rabies Vaccination Date

Vaccination Length
3 Year2 Year1 Year

Declawed
YesNo

Environment
Never Goes OutdoorsIndoor/Outdoor At WillOutdoor OnlyOutdoors only under my direct supervision

Do you trim your cat’s nails?
YesNoWould like to learn

Do you brush your cat’s teeth?
YesNoWould like to learn

Date of last dental cleaning (if applicable)

Other Pets in Household
Cat(s)Dog(s)Other

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