Registration Form
Please fill this form out to allow us to have some history before our first appointment together!
If registering more than one cat, please clearly identify your response to each question for EACH cat.
Email *
Owner and Spouse/Significant other's Full Names: *
Address: Street, City, ZIP: *
Phone 1 and phone type (H, W, Cell): *
Phone 2 and phone type (H, W, Cell):
Preferred contact method (text, email, phone):
Purpose of visit? *
If cat is ill, please describe:
First choice appointment date *
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First choice appointment time *
Time
:
Second choice appointment date *
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DD
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Second choice appointment time *
Time
:
Third choice appointment date *
MM
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DD
/
YYYY
Third choice appointment time *
Time
:
Cat’s name(s): *
Age(s)/DOB: *
Sex, spayed or neutered: *
Breed (short hair, long hair, Siamese...): *
Color:
Microchip # if known:
Indoor/outdoor? *
Diets fed (brands AND amounts of dry, canned, and treats): *
Date last FVRCP (distemper) vaccine given:
Date AND duration (1yr vs 3yr) of last Rabies vaccine given: *
Date last FeLV (leukemia) vaccine given (if applicable):
Prior vaccine reaction? *
If yes, describe symptoms:
Prior Vet: *
May Happy Cats Vet contact for records?
Clear selection
Prior Medical History: *
Current Medications (drug, supplement, or preventative name, dose and frequency): *
Adoption history (shelter, breeder, friend, stray):
Travel or origination outside of CO:
Other pets in home:
Recent vomiting or diarrhea? *
If yes, please describe type and frequency
Recent coughing or sneezing? *
If yes, please describe
Any increased thirst or urination? If yes, describe
Litter box accidents? *
If yes, describe
Mobility concerns?
Behavior with strangers? *
How did I hear about Happy Cats Housecall Vet? *
Due to COVID-19, non-urgent calls may take up to several business days to receive a response. We will get back to you as soon as possible! *
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