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 How should we contact you during today's appointment (drop off appts only)?* NOT A DROP OFF PHONE TEXT Email* Enter Email Confirm Email Best Phone Number for Appointment Day*(The clinic staff will use this number to communicate with you through the duration of your pet's appointment.)Date of Appointment MM slash DD slash YYYY 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) FeLV/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* Crossblock (topical flea prevention) Advantage Multi (topical flea/parasite prevention) Seresto collar (flea/tick for 8 months) 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.
