New Patient Information Please answer the following questions before your cat’s first appointment with us. This information will help us take the best care of your cat.Cat’s Name(Required) Date of Birth Month Day Year Is this date of birth an estimate? Yes No Gender(Required) Spayed/Neutered?(Required) yes no not sure Breed (Domestic Shorthair, Siamese, Persian, etc.)Color Has your cat been microchipped? yes no Microchip # How did you acquire your cat? (stray, adoption, breeder, etc.)How long has this cat been in your care? Is this cat covered by veterinary pet insurance? yes no My cat:(check all that apply) Is allowed to go outside Goes outside only with supervision Occasionally escapes Stays indoors always Lives with other household cats Lives with dogs Sometimes comes in contact with cats outside of the household Never comes in contact with cats outside of the household Previous veterinary hospital Please bring copies of your cat’s previous veterinary records to the appointment, if possible. Our staff can also contact your cat’s previous veterinary clinic or animal shelter to get their records, with your approval.What brand and type (wet/dry) of food do you feed your cat? How often do you feed your cat?(once a day, twice a day, food out all the time, etc.) How much do you feed your cat?(8 oz can, ¼ cup dry, 1 pouch, etc.) What kind of flea prevention do you use for your cat? How often?What other medications or supplements, if any, does your cat take?Has your cat been treated for any health problems (major or minor) or undergone surgery (other than a spay or neuter) in the past? Please describe:Anything else you’d like to tell us about your cat?Would you allow us to possibly share any photos we have taken of your kitty, either today or in the future, on one of our social media sites (Facebook or Instagram)? Yes! No, thanks. Your Name(Required) First Last Your Email(Required) PhoneThis field is for validation purposes and should be left unchanged. Δ
Cat Clinic of LawrenceCat Clinic of Lawrence
