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Feline Inappropriate Urination History Form

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Feline Inappropriate Urination History Form

Name *

First

Last

Phone

Email *

Pet's Name *

Is your pet taking any medication? *

Please list medications name, dosage/strength, and frequency *

Is your pet on any parasite preventatives? *

Name of Parasite Prevention *

When did you administer their last dose? *

Is your pet taking any supplements? *

Please list supplement name, dosage/strength, and frequency *

Does your pet go to any of the following facilities (please check all that apply): *

Boarding
Grooming
None of the above

Does your pet have access to outside? *

How often and are they supervised? *

Current Diet Brand *

Current Diet Amount *

Is your pet eating normally? *

Please explain:

Does your pet experience any of the following symptoms? (please check all that apply): *

Vomiting
Diarrhea
Coughing
Sneezing
Itching
Scratching
Increased Drinking
Increased Urinations
None of the above

Please explain (i.e. frequency, duration, etc.) *

Is your pet currently exhibiting inappropriate eliminations, such as urinating or defecating outside the litter box?

Please explain: *

Has your pet ever had seizures? *

When was your pet's last seizure? *

Do you have any concerns about your pet's behaviour? *

Please explain: *

Do you have any concerns about your pet's mobility or pain level? *

Please explain: *

Do you have any additional concerns about your pet or your appointment that you would like the doctor or team to know about? *

Please explain: *

Questions?

Get in touch! Complete our form, and a member of our team will be in touch with you shortly.

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Contact

Phone: 306-745-6642
Fax: 306-745-6643
E: tvvstaff@sasktel.net

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Location

424 Maple Street
Esterhazy, Saskatchewan
S0A 0X0

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Opening Hours

Monday: 8:00 am – 7:30 pm
Tuesday: 8:00 am – 12:30 pm; 1:30 pm – 5:00 pm
Wednesday to Friday: 8:00 am – 5:00 pm
Saturday-Sunday: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

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