Feline History Form – Cedarwood Veterinary Hospital

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Feline History Form

Name
First Last
Phone
Email
Date:
Date Format: MM slash DD slash YYYY
Patient:
Do you use Care Credit/ScratchPay?
- Yes
- No
Do you want information on financing options?
- Yes
- No
Do you want information on cutting cost with pet insurance?
- Yes
- No
Sex:
- Male
- Female
Spayed/Neuter:
- Yes
- No
Interested in Spaying/Neutering?
- Yes
- No
Microchip #:
Interested in Microchipping?
- Yes
- No
FELV / FIV tested?
- Yes
- No
Interested in Testing?
- Yes
- No
Age:
Weight:
Nails Long?
- Yes
- No
Nail Trim today?
- Yes
- No
Are there other pets in the household?
- Canine
- Feline
- Both Canine and Feline
How many pets live in the household?
Reasons for today’s visit?
Ongoing problems?
Current:
Medications/Supplements:
Any allergies to any medications or vaccines?
- Yes
- No
What and when?
Diet:
Brand:
Canned?
- Yes
- No
Dry?
- Yes
- No
How much do you feed?
How often do you feed?
Recent dietary changes?
What kind of treats / snacks / table scraps / chews do you give your pet?
When is the last time your pet ate?
Parasite Prevention:
What Heartworm Preventative do you give your pet?
What day of the month do you give your pet’s Heartworm Preventative?
Every month?
- Yes
- No
What Flea and Tick Preventative do you give your pet?
Interested in Heartworm or Flea and Tick Preventative today?
- Yes
- No
Lifestyle:
- Indoor only
- Indoor / Outdoor
- Outdoor Only
- Hunts
- Boards
- Groomed
- Travel
Feline Wellness History Questionnaire
Urine:
- Normal
- Increased
- Decreased
- Blood Present
Comments:
Bowel Movements:
- Normal
- Increased
- Decreased
- Diarrhea
- Constipation
- Blood Present
Comments:
Dental Status:
- Bad Breath
- Sore Gums
- Problems Chewing
- Drooling
- Decreased Appetite
What Dental care do you provide for your pet at home?
Mobility / Activity:
- Normal
- Unable to jump
- Limping
- Sore
- Painful
- Arthritic
Hair / Coat:
- Clean and Shiny
- Dull
- Dandruff
- Hair Loss
- Mats
- Decreased Grooming
Are any Fleas present?
- Yes
- No
Any bumps or masses that the Doctor should be aware of?
- Yes
- No
If yes, where and when was it seen, and changes?
Does your pet have any of these symptoms?
- Coughing
- Vomiting
- Diarrhea
- Sneezing
- Hairballs
Has your pet been seen elsewhere for medical care since we last saw him / her?
- Yes
- No
If so, when?
Clinics name:

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Contact

P: (423) 623-4362
E: cedarwood4362@gmail.com

Hours

Mon-Fri: 8:30 am-5:30 pm
Closed daily 12:30 pm – 2:00 pm

Address

1111 E Highway 25 70
Newport, Tennessee, 37821

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New Clients
- New Client Registration Form
About Us
Services
Pet Health
Contact Us
Pharmacy