New Patient Form

Gender
Male Female

Neutered/Spayed?
Yes No Unknown

Adoption History

Other (please elaborate)

How long has your cat been with you?

Temperament

Briefly describe your cat’s personality (e.g., shy, fearful, social, anxious, etc.):

Social Environment - Relationship with Other Pets

How does your cat get along with the other pets, if any, within the home? Please list the other pets’ names, ages, and species:

If there are other cats within the home, what behaviors occur between them?
Cuddle and groom each other Close contact, but no touching Tolerate one another Stare or block certain areas so another cat cannot pass Avoid one another Fight occasionally Other

Other (please elaborate)

Home Life

Does your cat go outdoors?
Yes No

What is the outdoor access?
Free access Outdoor enclosure (e.g. catio, screened porch) Walk on leash/harness Strictly supervised Other

Number of litter boxes:

Are any covered?

Automatic?

Type of litter?

Where are they located?

What do you feed your cat (brand/flavors if known)?

How much does your cat eat per day?

Canned/Wet Food (please specify amount):

Dry Food (please specify amount):

New Patient Form

Owner Information

Cat Information

Adoption History

Temperament

Social Environment - Relationship with Other Pets

Home Life