Feline Patient Admission Form

CAT INTAKE

Patient’s Name*

First Last

Patient's age*

Please specify years, months, or weeks

Sex*

Neutered Male
Intact Male
Spayed Female
Intact Female

Breed*

Reason for appointment*

Duration of primary concern?*

Do any family members have food allergies as we use treats with our patients?*

Does your pet have any food allergies?*

Does your pet have anxiety issues in veterinary clinics or during transport?*

Please describe below as we often will give medication to ease the fear, anxiety and stress associated with the visit

Is your pet insured, if so please list company and policy so we can facilitate your claim*

CONTACT INFORMATION

Are there any changes to your contact information (if a returning patient)?

No
Yes

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

COVID PROTOCOL

We respectfully request that you wear a mask in the clinic during the appointment. We also ask that you try to keep the number of people in the room to three or less. Not everyone on staff has had covid, we do have staff with immune system issues and staff with very young children. In order to continue to staff the clinic appropriately and serve your needs we need to continue to be as careful as possible

Owner Signature*

HEALTH HISTORY

Has your cat been vaccinated/dewormed anywhere else besides Tamarack Veterinary Clinic since your last visit here?*

Yes
No

What other pets live in the house?*

Does your pet:*

Hold the CTRL button to select multiple options.

How many litter pans do you have in the house?*

Does your cat go outside or live with another cat that does?*

Yes
No

Brand and type of food fed (canned/dry)?*

Which treats do you offer your cat?*

Are you giving any prescription or non-prescription medications or supplements to your cat*

Has your cat had any adverse drug reactions previously?*

Is your cat experiencing any coughing/sneezing/vomiting/diarrhea or experiencing any change in drinking/urination/appetite?*

Does your cat have any behavioral concerns?*

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*

Date*

CAT INTAKE

CONTACT INFORMATION

COVID PROTOCOL

HEALTH HISTORY

Have a Question? Need to book an appointment?

Connect with us and one of our team members will be happy to assist you.

CONTACT

2531 – 17th Street NW
Edmonton, AB
T6T 0Y2

Phone: 780-250-1700
Fax: 780-250-1705
Email: [email protected]

HOURS

EMERGENCIES

For after-hours please contact either:

Pulse Veterinary Specialists and Emergency
320-450 Ordze Rd Sherwood Park, AB
(780)-570-9999

VCA Guardian Veterinary Emergency and Specialist Centre (780) 436-5880

Contact Us