Medicating Consultation Questionnaire 1 Owner Information First Nameno-icon Last Nameno-icon Addressno-icon no-icon Cityno-icon Stateno-icon Zip Codeno-icon Cell Phoneno-icon Alternate Phoneno-icon Emailemail Who referred you to us?(your vet, Google, friend, etc.)no-icon Pet Information Nameno-icon Breedno-icon Date of Birthicon-calendar Ageno-icon SexMaleFemale Is your cat spayed/neuteredYesNo Is your cat declawed?YesNo Which Paws?Front pawsAll four How do you feed your cat?(i.e. food out all the time, meals, timed feeder)no-icon What brand of food do you feed?no-icon What type of food do you feed?CannedDryBoth If you do not feed canned food, does your cat like it?no-icon Does your cat like cat treats or any human foods? If yes, please list ALL of them!no-icon Veterinarian Information Name of current vet practiceno-icon Name of veterinarian you see thereno-icon Clinic Phone Numberno-icon Clinic/doctor's emailno-icon Have you visited this veterinarian for this problem and have they prescribed the current medications that you are experiencing challenges administering?no-icon May we contact them for records?no-icon Medical Information What 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-icon What medication(s) were prescribed?no-icon In what form?(check all that apply to what you have tried)PillsLiquidsInjectionsTransdermal GelCompounded/medicated treatsPowders Other Have you ever been successful medicating this cat? If yes, what worked?no-icon What 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-icon Can you otherwise touch, handle and interact with your cat?no-icon Does your cat hide from you? At meds time or all the time?no-icon Can you pick your cat up?no-icon Can you trim your cat's nails?no-icon Anything else you wish to share that would help us, help you?no-icon Legal 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
