Highlands Veterinary Hospital - New Feline Patient

1

Owner Information* This field is required.

Name

Phone

Email

2

Pet Information* This field is required.

Name of Pet

Estimated Age or Birthdate

Breed

Color

3

How long have you owned this pet?

4

Hair Coat Length (circle one)* This field is required.

Short

Medium

Long

6

Does your cat have a microchip?

YESNO

7

Does your cat live (circle one)?

Inside Only

Outside Only

Inside & Outside

8

Does your pet have any known or suspected food or drug allergies?* This field is required.

Yes

No

9

If yes, please describe

10

Previous Medical Conditions

11

Previous Surgeries or Serious Illnesses (date and description)

12

Please list any long-term medication(s) and/or supplements pet is taking, please include dosage if known?

13

Additional concerns or information

14

Would you like us to request records for this pet from another veterinary facility?

Yes

No

15

If yes, name of facility

16

My cat is aggressive toward

Yes

No

Other Animals

Other people

Other Animals

Other people

Yes

No

Yes

No