Do you already have an appointment scheduled at Cat Clinic of Iowa City?

Yes
No

Appointment Date / Time *

Date

Time

Client’s Information

Name *

First

Last

Preferred pronoun

He/Him
She/Her
They/Them

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Cell Phone Number *

May we text you at this number?

Yes
No

Alternative Phone Number (if applicable)

Alternative Phone Type

Home
Work
Other or None

Phone Number

Add an additional pet parent? *

Yes
No

Name *

First

Last

Phone *

Email *

How did you hear about us? If you were referred by someone, whom can we thank? *

Patient’s Information

Patient’s Name *

Species *

Breed *

Domestic short hair
Domestic medium hair
Domestic long hair
Other

If you chose other, please specify

Date of Birth or Approximate Age *

Sex *

Intact Male
Neutered Male
Intact Female
Spayed Female

Color

What is their diet?

Do they have any known allergies?

Are they on any flea, tick, and/or heartworm preventatives?

Are they on any medications currently?

Do they have any chronic illnesses?

Have they had any major surgeries?

What, if any, veterinary practice(s) have they been seen at previously?

Please upload a copy of your pet’s medical history including vaccine status, or have your previous vet send it to us directly at catclinicic@gmail.com.

Click or drag files to this area to upload. You can upload up to 10 files.

Do you have a second pet? *

Yes
No

Patient’s Name *

Species *

Breed *

Domestic short hair
Domestic medium hair
Domestic long hair
Other

If you chose other, please specify *

Date of Birth or Approximate Age *

Sex *

Intact Male
Neutered Male
Intact Female
Spayed Female

Color

What is their diet?

Do they have any known allergies?

Are they on any flea, tick, and/or heartworm preventatives?

Are they on any medications currently?

Do they have any chronic illnesses?

Have they had any major surgeries?

What, if any, veterinary practice(s) have they been seen at previously?

Please upload a copy of your pet’s medical history including vaccine status, or have your previous vet send it to us directly at catclinicic@gmail.com.

Click or drag files to this area to upload. You can upload up to 10 files.

Do you have a third pet? *

Yes
No

Patient’s Name *

Species *

Breed *

Domestic short hair
Domestic medium hair
Domestic long hair
Other

If you chose other, please specify *

Date of Birth or Approximate Age *

Sex *

Intact Male
Neutered Male
Intact Female
Spayed Female

What is their diet?

Do they have any known allergies?

Are they on any flea, tick, and/or heartworm preventatives?

Are they on any medications currently?

Do they have any chronic illnesses?

Have they had any major surgeries?

What, if any, veterinary practice(s) have they been seen at previously?

Please upload a copy of your pet’s medical history including vaccine status, or have your previous vet send it to us directly at catclinicic@gmail.com.

Click or drag files to this area to upload. You can upload up to 10 files.

Do you have a fourth pet? *

Yes
No

Patient’s Name *

Species *

Breed *

Domestic short hair
Domestic medium hair
Domestic long hair
Other

If you chose other, please specify *

Date of Birth or Approximate Age *

Sex *

Intact Male
Neutered Male
Intact Female
Spayed Female

Color

What is their diet?

Do they have any known allergies?

Are they on any flea, tick, and/or heartworm preventatives?

Are they on any medications currently?

Do they have any chronic illnesses?

Have they had any major surgeries?

What, if any, veterinary practice(s) have they been seen at previously?

Please upload a copy of your pet’s medical history including vaccine status, or have your previous vet send it to us directly at catclinicic@gmail.com. *

Click or drag files to this area to upload. You can upload up to 10 files.

Do you have a fifth pet? *

Yes
No

Patient’s Name: *

Species *

Breed *

Domestic short hair
Domestic medium hair
Domestic long hair
Other

If you chose other, please specify *

Date of Birth or Approximate Age *

Sex *

Intact Male
Neutered Male
Intact Female
Spayed Female

Color

What is their diet?

Do they have any known allergies?

Are they on any flea, tick, and/or heartworm preventatives?

Are they on any medications currently?

Do they have any chronic illnesses?

Have they had any major surgeries?

What, if any, veterinary practice(s) have they been seen at previously?

Please upload a copy of your pet’s medical history including vaccine status, or have your previous vet send it to us directly at catclinicic@gmail.com.

Click or drag files to this area to upload. You can upload up to 10 files.

Reason for appointment *

Online Forms

New Client Form for Cat Clinic of Iowa

Cat Clinic in Iowa City, IA

Save Time and Fill out Forms Online

Client’s Information

Patient’s Information

Visit our cat clinic

Book An Appointment

Address

Contact

Hours

Have a question?