Feline Wellness Profile Feline Wellness Profile Please fill out and submit this form prior to your pet's wellness visit. We look forward to seeing you! Pet's Name*Owner's Name* First Last Email* Best Phone Number for Appointment Day*Date of Appointment Has your pet ever had any vaccine reactions?* **YES - Please also advise the staff of this at the time of your appointment.** No Is your pet microchipped?* Yes - Please check the chip at this visit. No - Please microchip my pet at this visit. No - I am not interested at this time. Please see http://farmandfamilyvet.com/services/microchipping/ for more info.I feed my pet...* Dry food Canned food Treats People food Select all that apply.Brand of Food* Hill's Science Diet Purina ProPlan Royal Canin A Prescription Diet Dental Care - Do you give or do any of the following?* Teeth brushing regularly Dental Treats (Greenies, etc.) Dental Rinses Annual Dental Exam & Cleaning None of these Is your cat getting flea and/or tick preventative monthly?* Yes - every month Yes, but I've missed a month or two this year Yes, but not regularly at all No, not on preventative Does your cat go outside?* Indoor only Goes outside supervised only Goes outside rarely Indoor/outdoor Outdoor only Has your cat been tested for Feline Leukemia (FeLV) and Feline Immunodeficiency virus (FIV)?* Yes - Negative Not sure No Services you would like performed today:* *Rabies vaccine FVRCP - Feline Upper Respiratory vaccine (all cats) Feline Leukemia vaccine (cats that go outside) Feline Leukemia & FIV test Microchip Nails trimmed All pets will get a full wellness exam. *Rabies is now required for cats by IL state law. A staff member will review your choices and let you know if there are any questions.Prevention Needed Prescribed or Refilled* Revolution Plus (topical flea, tick, intestinal worms & earmites) Crossblock (topical flea prevention) Whatever they got last year None Number of doses requested:*Anything else you would like the staff to know today or questions you might have?*File Upload Drop files here or Select files Accepted file types: jpg, pdf, gif, png, jpeg, Max. file size: 128 MB. You may attach previous records from another vet clinic or shelter here if needed. Please use pdf or jpg if possible. Alternately, you can email them to farmandfamilyvet@gmail.com with your pet's first and last name as the subject.
