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Feline Client Intake Form

Your Name (required)

Your email address (required)

Your Telephone(required)

Your Mailing Address (required)

Preferred method of Contact?
 Email Phone Both
Cat's Name

Breed

Sex  Male Female
Sterilization [Sterilization checkbox* "Spay" "Nueter"]
Date of Birth
Color/Markings
Is your cat a service/therapy cat?
Current Veterinarian Name and Contact Info

Is your cat up to date on vaccinations?

Is your cat on any medications? *If yes…What are they?

Has your cat had any surgery within the past year?*If yes…What and when?

Has your cat had an injury that is still affecting him/her? *If yes…Please explain.

Is your cat experiencing any problems with daily activities? If yes…What are they?

Is your cat involved in any competition or sport? Ie Cat Shows, Agility, etc.

Has your cat had a massage before? If yes…When and where?

Why is your cat having a massage performed now?

Did I miss anything? Please feel free to add additional comments or anything I need to know!

I understand that massage and other modalities are never a replacement for veterinary care and/or treatment. I understand that the massage therapist is certified to provide massage for animals and will not diagnose or prescribe treatment, attempt any adjustments/musculoskeletal manipulations (though the cat will sometimes adjust themselves during a massage) nor prescribe any supplements or medication for my cat. If my cat is currently under veterinary care, I have cleared this work with the attending veterinarian to ensure massage is at this time an appropriate and safe decision.

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