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Employment

503-655-1722 22320 Salamo RoadWest Linn,
OR 97068

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22320 Salamo Rd,
West Linn, OR 97068

Call / Text: 503-655-1722

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Home » Feline Annual Exam

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

Entering Your Full Name Here Will Serve As Your Digital Signature:*

Date*

MM slash DD slash YYYY

CAPTCHA

Phone

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

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Cascade Summit Animal Hospital © 2020
22320 Salamo Road, West Linn OR 97068

Call or Text 503-655-1722

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Oregon Veterinary Medical Association

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Monday – Friday:
8:00am – 6:00pm

Saturday – Sunday:
Closed