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22320 Salamo Rd,
West Linn, OR 97068

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Emergency

FELINE ANNUAL EXAM HISTORY

Feline Annual Exam History

"*" indicates required fields

Pet Name:*

Client Name*

First Last

Name & Phone Number for Decisions*

Email*

Do you have time constraints?*

Does your pet have insurance?*

Yes

No

If "Yes" above please let us know which Insurance Company

For today's visit the following symptoms are present:

No symptoms present

Coughing

Sneezing

Vomiting

Diarrhea

Lethargy

Lameness

Itching

Lumps/Bumps

Other Symptoms/Concerns (list):

Other Symptoms/Concerns (list):*

Monthly heartworm / deworming / flea preventive:*

None

Bravecto

Revolution

Cheristin

Vectra

Frontline

Advantage

Current medications/supplements and dose given:*

Diet:*

Appetite:*

Normal

Decreased

Increased

Any change in food/treats?*

YES

NO

Water Intake*

Normal

Decreased

Increased

Activity Level*

Normal

Abnormal

Food Allergies?*

Other Allergies?*

Any seizures?*

Percentage of time spent indoors:*

HISTORY

How is your pet doing at home?*

Have you noticed any changes to their normal behavior?*

YES

NO

What concerns that you would like to address today?*

Do you need any medication refills?*

YES

NO

Other

Vaccine Lifestyle Information and Consent

Is there exposure to other cats (outdoors/boarding/grooming)?*

YES

NO

Is there exposure to wildlife (bats/raccoons/skunks/etc.)?*

YES

NO

Vaccines Accepted/Declined for Upcoming Year

FVRCP:*

Accepted

Declined

Rabies Vaccine Accepted/Declined for Upcoming Year:*

Accepted (1 year)

Accepted (3 year)

Declined

FeLV (leukemia vaccine for cats with exposure to other cats / outdoors):*

Accepted

Declined

Owner's Signature*

Date*

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Phone

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Cascade Summit Animal Hospital

22320 Salamo Rd
West Linn, OR 97068

Cascade Summit Animal Hospital is a full service animal hospital, providing medical, dental, diagnostic, surgical and holistic services

https://cascadesummitvets.com/

Hospital Hours

Monday	8:00 am - 6:00pm
Tuesday	8:00 am - 6:00pm
Wednesday	8:00 am - 6:00pm
Thursday	8:00 am - 6:00pm
Friday	8:00 am - 6:00pm
Weekend	CLOSED

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