Feline Preventive Visit

Feline Preventive Visit

History Information
Client Name*

First NameLast Name
Pet Name*
Date of Appointment*

MonthDayYear
Date
Phone # for call or text during pet's visit

Area CodePhone Number
Anything you want us to know about your pet since last visit?*
Time Spent Outside*

NeverOccasionally escapesSupervised only/ on a leashAs desired - in and outDoes not come in the house at all
Diet- Brand, Amount, Frequency; Treats? People food?*
Apptite*

NormalIncreasedDecreasedUnsureOther
Any change in thirst or urination?*
Monthly Prevention Product*

Revolution topical (heartworm, ear mites, intestinal worms, fleas) - only available via prescription from a vetRevolution Plus topical (all of above plus ticks) - only available via prescription from a vetFeline Heartgard Plus chewable (heartworm and hookworms) - only available via prescription from a vetSeresto Collar (8 months of killing fleas & ticks only)Frontline Plus or Gold topical (fleas & ticks only)NoneOther
Last given/applied

MonthDayYear
Date
Number of doses needed today to continue monthly year-round (best for your pet!)*
Best deal is to get 6 or 12 doses of Revolution for a rebate!
Please list any other medications or supplements*
Any signs of parasites?*
At a preventive care visit for healthy pets, we are able to pass along a great deal from our lab for a discounted preventive panel that includes Complete Blood Count, Metabolic Panel (Chemistry), Blood Infection (Leukemia & FIV), and Intestinal Parasite Screens:*

Basic (Adult) Panel (includes all of above) $132Premium (Senior) Panel for $219 (all of above plus urine and thyroid)Maybe- would like to discussFeline Leukemia, FIV, and Heartworm blood test with Intestinal Parasite ScreenIntestinal Parasite Screening (stool) only **all pets need this at least once per year!No preventive testing today
Any medical or behavioral questions or concerns today?*
How do you intend to pay for the visit?*
Contactless Payment preferred- we can send you a secure link to your cell phone that you can pay yourself with your card directly
In last 2 weeks, has pet had any potential exposure to person with symptoms of or that has been diagnosed with COVID19?
Should be Empty: