New Patient History Form (Cat)

Has your pet ever been hospitalized?*

YesNo

If yes, please explain:*

When was your pet's last dental cleaning?*

Any previous extractions or oral surgery?*

YesNo

Has your pet been diagnosed with any of the following? (please check all that apply.)

Any other symptoms? please describe:

Do you brush your pet's teeth?*

YesNo

How frequently?*

How does your pet like it?*

LoveHateTolerateN/A

Please list all toys that you give your pet:*

Please list all chews or other dental products that you give your pet:*

Does your cat have a history of being fractious, aggressive or difficult to handle at a veterinary office?

YesNo

Many pets are anxious and nervous in a clinical setting. If you feel your pet would benefit from anti-anxiety medications please speak with your primary care veterinarian prior to this appointment. We would like your pet to have the best experience possible.

Please list any other concerns or comments:

In the event you should need to reschedule, we require 48 hours advance notice. If you reschedule an appointment without contacting our office within the required time, this is considered a missed appointment and you will not be refunded the $210 deposit.*

I understand and agree to the missed appointment fee policy

May use photos of your pet and their teeth for social media purposes? We will never use your name, just your pet's first name.*

YesNo