New Kitten/Cat Intake Form

New Kitten/Cat Intake Form

Tsawwassen Animal Hospital
Today's Date

MonthDayYear
Date
If you already have an appointment scheduled, please enter the date of your appointment below. (Please note, this form cannot be used to schedule an appointment)

MonthDayYear
Date
Name

First NameLast Name
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Primary Email
example@example.com
Co-Owner's Name

First NameLast Name
Co-Owner's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pet's Name
Breed
Colour
Sex
Birth Date

MonthDayYear
Date
Is your cat spayed or neutered?
Length of time you have owned your cat
Name of previous veterinary clinic
Do we have your permission to call for previous veterinary records?

YesNo
Do you have health insurance for your cat?
Where did you obtain your cat?
Please list previous vaccination types and dates administered

Vaccination History- Please list dates administered

Date of last deworming
What diet are you feeding your cat
Diet- please select all that apply

DryCannedPeople food/table scraps
How many feedings per day?
Cat's Environment

Strictly Indoors OnlyIndoor/Outdoor with supervisionIndoor/Outdoor unsupervisedMostly Outdoors
Do you have other pets?

YesNo
If yes, please least name and species
Is your pet currently taking medication?

YesNo
If yes, please list medication name, dose and frequency
Do you give your cat supplements or vitamins?

YesNo
If yes, please list below
I feel my cat's weight is

Too LowIdealToo High
Do you brush your cat's teeth?

YesNo
Do you travel with your cat?

YesNo
Do you board your cat at a boarding facility?

YesNo
Is there anything else you'd like us to know about your cat?
Should be Empty: