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Feline Annual Form
1
Your Name
*
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First Name
Last Name
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2
Your Cat's Name
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3
Today's Contact Number
Area Code
Phone Number
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4
You can upload a photo of your cat here. This photo will be attached to their medical record.
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Max. file size
: 10.6MB
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5
Does your cat go outside?
*
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Yes
No
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6
Have you noticed more urine in the litter box or excessive drinking?
*
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Yes
No
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7
Does your cat vomit hairballs or food more than once a month?
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Yes
No
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8
Have you seen any evidence of fleas, ticks or parasites on ANY of your pets?
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Yes
No
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9
What food are you currently feeding?
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10
List all medications your cat is on, including flea and heartworm prevention:
*
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11
Last dose of heartworm and flea prevention given on:
-
Date
Year
Month
Day
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12
Does your pet bite at his/her skin, seem itchy or lick excessively?
*
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Yes
No
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13
Have you noticed any weight gain or loss?
*
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Weight Gain
Weight Loss
Neither
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14
Have you noticed any changes in behavior or activity level?
*
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Behavioral Change
Activity Level
Neither
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15
Have you noticed any signs of pain or discomfort?
*
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Hiding or Isolation
No longer jumping up
Sleeping more than usual
No pain or discomfort
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16
Have you seen any changes in behavior when urinating or defecating, like going outside the litter box?
*
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Urinating
Defecating
Neither
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17
Along with examination and vaccinations, our doctors recommend an additional labwork and urinalysis panel to detect underlying diseases. Would you like to do that today?
*
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Additional charges will apply.
Yes
No
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18
Do you need a refill of any of the following?
Bravecto (3 month Flea/Tick prevention)
Revolution Plus (Heartworm/Flea/Tick prevention for cats)
None
Other
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19
Does your pet need any additional services today? ie. nail trim
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