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22320 Salamo Rd,
West Linn, OR 97068

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Services
Holistic Care
About
Resources
Contact
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):*

Diet: (what brand of food and amount fed per day. i.e. 2 cups twice daily, 1/4 can three times daily)*

Any change in food/treats?*

YES

NO

Current medications/supplements and dose given:*

Monthly heartworm / deworming / flea preventive:*

None

Bravecto

Revolution

Cheristin

Vectra

Frontline

Advantage

Simparica Trio

Appetite:*

Normal

Decreased

Increased

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*

Month

Day

Year

Help us fight SPAM! Please tell us how many legs does a CAT have?*

The SUBMIT button will appear when the question is answered correctly.

Name

This field is for validation purposes and should be left unchanged.

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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