Feline Patient Assessment Questionnaire

In order to provide top quality care and service for you and your pet Country Chase Hospital is asking you to answer the following questions to the best of your ability. This questionnaire will help our doctors make recommendations for your pet based on the risk factors that they face individually. This fits our belief that each patient should be treated as an individual rather than taking a one size fits all approach. We want to vaccinate your pet with only the vaccines they need without over-vaccinating them with vaccines they will not need. We appreciate your help in this process.

Does your cat go outdoors?(Required)
Does your cat come in contact with other cats that go outdoors?(Required)
Does your cat go on a porch, patio or lanai?(Required)
Are there neighborhood cats or stray cats that visit your pets through screens?(Required)
Does your cat go to a professional groomer?(Required)
Does your cat board?(Required)
Have you noticed any new or growing lumps on your pet?(Required)

What kind of heartworm and Flea Prevention do you use for your cat?

Have you missed any doses?(Required)

What types and brands of foods and treats do you feed your cat?

In the event life saving measures are needed, do you authorize us to do so?(Required)


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12501 W. Linebaugh Ave.

Tampa, FL 33626

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8:00am - 6:00pm
8:00am - 6:00pm
8:00am - 6:00pm
8:00am - 6:00pm
8:00am - 6:00pm
9:00am - 5:00pm