Veterinary Feline Check-InName First Last Pet Name First Pet Sex Male FemalePet Age Kitten Adult SeniorDate of Visit MM slash DD slash YYYY Reason for VisitHAS YOUR PET EVER HAD A VACCINE REACTION? Yes NoDOES YOUR PET HAVE ANY MEDICATION ALLERGIES OR INTOLERANCES? Yes NoWould you like your pet updated on their vaccines today? Yes NoHas your pet ever been tested for FIV/Leukemia? Yes No UnsureProcedures Nail Trim ($15) Sanitary Clip ($10) Microchip ($42) Ear Cleaning ($16.50)Does your cat live…….. Indoor Outdoor Indoor/OutdoorWhat other pets does your cat live with?How many litter boxes do you have and where are they located?What types of toys does your cat have available?Does your Pet have a Microchip? Yes NoMicrochip #Brand of food fed:Please select the type of food.WetDryAmount of food fed:How often is your pet fed? 1x Daily 2x Daily 3x Daily Treats Offered Yes NoTable Food Yes NoHave there been any changes in your pet’s appetite? Yes NoDecreased or Increased for how long?Have there been any changes in your pet’s water intake? Yes NoDecreased or Increased for how long?Medications/Parasite PreventionsCurrent Medications or Supplements: Flea PreventionProductDate of last dose1mth, 6mth or 12mth HW PreventionProductDate of last dose1mth, 6mth or 12mth Health StatusVomiting/DiarrheaPlease explain, how often, duration and appearanceCoughing/Sneezing/Nasal dischargePlease explain, how often, duration and appearanceLumps/BumpsPlease explain: Where are they located? How long have they been present? Has there been any color or size change?Itching/Hair loss/Skin lesionsPlease explain where and duration:Limping/LamenessPlease explain, which limb and how long:Have there been any changes in your pet’s behavior?If yes, please explainAny Other Problems that you have noticed? *Bad Breath *Loss of Balance *Breathing Problems *Difficulty rising *Change in sleeping habits *Changes in Hair Coat *Excessive Frequency of Urination *Excessive amounts of Urine *Scooting *Straining to Urinate/Defecate *Bleeding gums *Shaking Head *Squinting/runny eyes *Abnormal BM’s *Loss of Energy *Behavior Problems- Aggression, Storm phobia or Separation AnxietyDuration of these problems?Any Other problems/concerns that you would like to discuss with the Doctor?Are the any pre-existing health issues that we need to be aware of?Mobile PhoneHome PhoneEmail Best time to call:OK to text or email?In lieu of a physical signature, I agree and have checked to be certain the information I am submitting is correct for my pet's visit.