Medicating Consultation Questionnaire 1 Owner InformationFirst Nameno-iconLast Nameno-iconAddressno-iconno-iconCityno-iconStateno-iconZip Codeno-iconCell Phoneno-iconAlternate Phoneno-iconEmailemailWho referred you to us?(your vet, Google, friend, etc.)no-iconPet InformationNameno-iconBreedno-iconDate of Birthicon-calendarAgeno-iconSexMaleFemaleIs your cat spayed/neuteredYesNoIs your cat declawed?YesNoWhich Paws?Front pawsAll fourHow do you feed your cat?(i.e. food out all the time, meals, timed feeder)no-iconWhat brand of food do you feed?no-iconWhat type of food do you feed?CannedDryBothIf you do not feed canned food, does your cat like it?no-iconDoes your cat like cat treats or any human foods? If yes, please list ALL of them!no-iconVeterinarian InformationName of current vet practiceno-iconName of veterinarian you see thereno-iconClinic Phone Numberno-iconClinic/doctor's emailno-iconHave you visited this veterinarian for this problem and have they prescribed the current medications that you are experiencing challenges administering?no-iconMay we contact them for records?no-iconMedical InformationWhat medical conditions are currently being treated in your cat?(i.e. kidney disease, hyperthyroidism, diabetes, a behavior problem requiring long-term anti-anxiety medications, etc.)no-iconWhat medication(s) were prescribed?no-iconIn what form?(check all that apply to what you have tried)PillsLiquidsInjectionsTransdermal GelCompounded/medicated treatsPowders OtherHave you ever been successful medicating this cat? If yes, what worked?no-iconWhat specific challenges are you having?(i.e. can't catch cat, being bitten when pilling, meds tatse terrible and they are foaming at the mouth)no-iconCan you otherwise touch, handle and interact with your cat?no-iconDoes your cat hide from you? At meds time or all the time?no-iconCan you pick your cat up?no-iconCan you trim your cat's nails?no-iconAnything else you wish to share that would help us, help you?no-iconLegal StuffBy submitting this questionnaire, I understand that the recommendations given by Fundamentally Feline are in no way a substitute for veterinary care.I understand that the success depends upon my compliance and ability to follow through with the skills learned to become proficient. In some rare cases, some cats cannot be medicated without it affecting the pet/parent relationship and without affecting quality of life. I release Fundamentally Feline from any and all liability in regard to health and behavior of my pets, the safety of all people in the household who interact with the cat, damage or loss to my property and in regard to any aspect of the advice given.I understand that payment is due in full at the time of service.Submit Form keyboard_arrow_leftPrevious Nextkeyboard_arrow_right
