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New Client Registration Form
Please fill this form out to allow us to have some history before our first appointment together!
Email address *
Owner and Spouse/Significant other's Names: *
Your answer
Address: Street, City, ZIP: *
Your answer
Phone 1 and type (H, W, Cell): *
Your answer
Phone 2 and phone type (H, W, Cell):
Your answer
Preferred contact method (text, email, phone):
Your answer
Cat’s name(s): *
Your answer
Age(s)/DOB: *
Your answer
Sex, spayed or neutered: *
Your answer
Breed (short hair, long hair, Siamese...): *
Your answer
Color:
Your answer
Microchip # if known:
Your answer
Indoor/outdoor? *
Date last FVRCP (distemper) vaccine given:
Your answer
Date AND duration (1yr vs 3yr) of last Rabies vaccine given: *
Your answer
Date last FeLV (leukemia) vaccine given:
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Prior vaccine reaction? *
If yes, describe symptoms:
Your answer
Prior Vet: *
Your answer
May Happy Cats Vet contact for records?
Purpose of visit? *
If cat is ill, please describe:
Your answer
Prior Medical History: *
Your answer
Diets fed (brands AND amounts of dry, canned, and treats):
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Current Medications (drug, supplement, or preventative name, dose and frequency): *
Your answer
Adoption history (shelter, breeder, friend, stray):
Your answer
Travel or origination outside of CO:
Your answer
Other pets in home:
Your answer
Litter box accidents? *
If yes, describe
Your answer
Mobility concerns?
Your answer
Behavior with strangers? *
Your answer
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