New Patient Information – Cat Clinic of Lawrence

Cat’s Name(Required)

Date of Birth

Is this date of birth an estimate?

Yes

Gender(Required)

Spayed/Neutered?(Required)

yes

not sure

Breed

(Domestic Shorthair, Siamese, Persian, etc.)

Color

Has your cat been microchipped?

yes

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

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

Is this cat covered by veterinary pet insurance?

Yes

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)

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Your Email(Required)

Comments

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Monday	8 am - 5:30 pm
Tuesday	8 am - 5:30 pm
Wednesday	closed
Thursday	8 am - 5:30 pm
Friday	8 am - 5:30 pm
Saturday	closed
Sunday	closed