Please complete this form. Click on Submit when ready to send. Taking the time to return this form, allows me to keep accurate health records, and work constantly towards improving the health and temperament of cats in my breeding program. THANK YOU!

1) Name

2) Email Address

3) Postal Address

4) Home Phone Number

5) Cell Phone

6) Your Veterinarians Name

7) Name of Veterinary Clinic

Address of Veterinary Clinic

Phone Number

8) Cats pet name

9) Cats Registered Name

10) How would you describe your cat's personality?
Total Extrovert Generally Friendly Friendly with people s/he knows Timid
Comments

11) How would you describe his/her adult coat?
Suede Patchy Woollen Wavy
Comments

11) Does your cat wander?
Belongs to the neighbourhood Has a large territory Sticks close to home Prefers to stay inside
Comments

12) Does your cat mark his/her territory
Never Outside only Inside occasionally Inside when stressed
Comments

13) If your cats marks territory, have you sought treatment? Yes No

14) What treatment have you tried?

15) Has the treatment helped the behaviour? Yes No

16) Has your cat maintained good health Yes No

17) Has s/he suffered from any skin complaints? Yes   No
     Describe the rash, colour, area affected, amount of distress
     Did it require treatment?
     How successful was the treatment? Not at all   Minimally   Excellent

18) Has s/he ever developed a cough? Yes   No
      Comments
        Did it require treatment?

19) Has s/he ever been diagnosed with a heart murmur? Yes No
Details

20) Has s/he ever developed a limp Yes No
Details

21) Has s/he ever suffered from an upper respiratory infection Yes No
Details

22) Has s/he ever suffered from an eye infection Yes No
Details

23) Has your cat ever suffered from a urinary problem? Yes No
Urinary Infection Bladder stones Haematuria Other
Comments

24) Has your cat ever suffered from bad breath/teeth? Yes No
      Has s/he required treatment for this Yes    No
      Was the cause Bad Teeth Gingivitis Other
      Details

25) Are there any health or behavior issues not mentioned you feel I need to know about?

26) Do you have any suggestions to improve this form and feedback?

Thank you very much for making the time to complete this form.

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