Feline Patient Admission Form

*

I have NOT recently traveled outside of Canada
I HAVE recently traveled outside of Canada

*

I do NOT feel ill or am exhibiting respiratory illness signs
I AM feeling ill or I AM exhibiting respiratory illness signs

*

I have NOT been in contact with an individual that has tested positive for COVID-19
I HAVE been in contact with an individual that HAS tested positive for COVID-19

*

I am NOT bringing an animal into the clinic that has been around a person that has tested positive for COVID-19. Pets can act as fomites.
I AM bringing an animal into the clinic that HAS been around a person that HAS tested positive for COVID-19. Pets can act as fomites.

Do you or any family members have any food allergies? (ie: peanut butter)*

Yes
No

If yes, please list them:*

Consent for Required Carrier*

I consent
I do not have a carrier for my pet, therefore, I will need TVC to provide one for me at time of curbside service.

Tamarack Vet clinic is not responsible for any cat that gets loose from the time of contact at the vehicle to entering the clinic. If you do not have a carrier for your cat, please let our staff member know and we will provide one for you.

Owner Name*

First Last

Pet Name*

Age*

Please specify weeks/months/years*

Weeks
Months
Years

Sex*

Female
Spayed Female
Male
Neutered Male

Reason for appointment*

Describe in detail please

Duration of symptoms for current concerns?*

Date of last vaccinations? What Clinic?*

Any Previous Reaction to Vaccination?*

Are there Any Other Pets in the Household/What Type?*

How Many Cats In The House? How Many Litter Pans?*

Select all that apply to your cat:*

My Cat Goes Outdoors Unsupervised
My Cat Goes Outdoors Supervised
My Cat Will Board In A Kennel When We Are Away
My Cat Is A Hunter
My Cat Will Travel/Has Traveled Outside Of Alberta
My Cat Lives With A Cat Who Does Go Outside
None of the above apply to my cat

If your cat has travelled outside Alberta, please list where and when.*

Date of Last Deworming? Product Used?*

Brand of Food Fed? How Much/How Often? Canned/Dry?*

Treats Fed/Brand?*

List Current Medications and/or Supplements including dose:*

If so, please list name/dose/last given

Any Known Allergies?*

Any environmental changes?*

Any Reaction to Medications?*

Any Concerns under Anesthesia?*

Any Recent Change in Weight?*

How is their appetite?*

Poor
Good
Excellent

When did they last eat?*

Has There Been Any Coughing or Sneezing?*

If so, please describe

Has There Been Any Vomiting or Diarrhea?*

If so, please describe

When was their last bowel movement?*

Have You Noticed Any New Lumps?*

Has There Been Any Recent Change In Drinking Or Urinating Amounts?*

How is their behaviour?*

Lethargic
Normal
Hyperactive

List Previous Health Concerns:*

Do You Have Any Additional Current Concerns?*

Do you have pet insurance, if so, what company?

Please list the policy number.

Consent

FOR NEW CLIENTS/PATIENTS ONLY - I hereby grant Tamarack Vet Clinic LTD permission to take photographs of myself and/or my pet(s), and to publish those photographs for any lawful purpose, including but not limited to, their website, social media accounts, and promotional materials, either digital or in print, in perpetuity. I also grant permission to use my name and/or my pet(s) name.

By signing and dating this document, I authorize Tamarack Vet Clinic LTD to edit, alter, share, remix, tweak, build upon or in any way alter the photograph(s) mentioned above. I also waive any rights of privacy or compensation associated with the use of my or my pet(s) images(s) and name(s) for the personal or commercial purposes outlined above.

Owner Signature

Best phone number to contact you during the time of appointment*

Date

Contact Us

Hours of Operation

Scratchpay

Emergencies

Healthsmart

Contact Us