Client Name *

Telephone *

Street Address, City, State, Zip Code *

Email*

Emergency Contact *

Will you be available by phone while on travel? YesNo

Cat Name *

Vet Clinic Name *

Health Conditions/Meds

Do you have proof of flea treatment? YesNo

Proof of Flea Treatment: Please provide proof of flea treatment. All cats without proof of flea treatment will be administered a monthly dose of treatment for $20.

Feeding Instructions:

Brand of Cat Food:

My Cat has been fed todayMy Cat has free access to food (free feeding)

Feeding Instructions

In the event my cat food restricts, I authorize the following:

Food Motivator ($3 each)TunaBeef Baby FoodWet foodHydration through Sub-Cutaneous Fluids ($15 each)Manual Feeding ($25 each)

Food restriction (anorexia) can be life threatening. If anorexia persists, go to the vet after *

Medications:

My cat is on medicationThe instructions on the medication are accurate. Please follow the instructions on the medication containerThe instructions on the bottle are not accurate

Please provide medication name, dosage and instructions

Cats on insulin who food restrict must have blood glucose monitoring at $8.50 per measurement

If my cat requires medical attention:

Socialization / Co-Mingling:

My cat is allowed to socialize and co-mingle with other cats? YesNo

Additional Services:

Grooming (fees posted on website): Nail TrimBath, Dry, BrushShave with BathDe-Shedding with BathDe-Matting with Bath

Daily Treats ($1 each day): Fish FlakesGreeniesDental HealthOrganic Cat-Nip

Extra Petting & Playtime ($10 each session 15 mins):DailyEvery Other Day

Toys: Flying Feather ($10)Catnip Toy ($4)Bell Toy ($1)

Catio (Available at Sellwood and Tabor):

My cat is allowed to enjoy the secure outdoor Catio (secure outdoor patio) : YesNo