Cat’s Name_____________________________ Date__________
*Cats must be in good health to receive vaccinations; those cats with health concerns may not be
vaccinated and should be seen by a full service veterinary clinic. There are a small percentage of cats
that will have an allergic reaction to the vaccinations. Please advise the veterinarian if your cat has
had a previous allergic reaction to vaccines.
ALL CATS MUST BE IN A CARRIER OR SECURE BOX!
Cats over 1 year of age
Rabies 1 year $16.00_________ (first Rabies, expired Rabies, or unknown history; booster in 1 year)
Rabies 3 year $16.00_________ (last Rabies has not yet expired; booster in 3 years)
4in1 (Distemper) $14.00_________ (booster in 3-4 weeks if this is first vaccine or history is unknown)
Feline Leukemia $14.00_________ (recommended for outdoor cats; booster in 3-4weeks if this is first
vaccine or history is unknown)
Mini Package (3 year Rabies available only if last Rabies has not yet expired)
1 year Rabies + 4in1 $27.00_______ 3 year Rabies + 4in1 $27.00_______
Full Package (3 year Rabies available only if last Rabies has not yet expired)
1 year Rabies, 4in1, Feline Leukemia $37.00_______ 3 year Rabies, 4in1, Feline Leukemia $37.00_______
Feline Leukemia/FIV/HW Combo Test $22.00_________ (recommended for cats with unknown history)
Test Results: FeLV Negative Positive / FIV Negative Positive / HW Negative Positive
Dewormer
Hookworm, Roundworm and Tapeworm
Profender (topical) (8+weeks of age) $15.00__________
Hookworm and Roundworm only
Strongid-T (6+ weeks of age)_______cc $12.00___________
Ear Mite Treatment Milbemite $14.00__________
Flea Control Flea and Tick Control
Advantage Individual Dose $12.00__________ Frontline Plus Individual Dose $14.00__________
Advantage up to 9 lbs (4 months) $41.00__________ Frontline Plus (3 months) $35.00__________
Advantage over 9 lbs (4 months) $41.00__________
Interceptor Heartworm Preventative (recommended for outdoor cats)
Cats Individual dose $ 8.00 __________ Cats 1.5 to 6 lbs (6 months) $33.00__________
Cats 6.1 to 12 lbs (6 months) $34.00__________ Cats 12.1 to 25 lbs (6 months) $37.00__________
AVID Microchip with Registration $20.00__________
Cat Carrier $7.01___________
Vaccine Clinic Questionnaire for Cats Your Client #_________
*You will be called by your Client #; please return this completed form to the front desk
Cat’s Name_____________________________ Age__________ Weight_________ Male________ Female________
Spayed/Neutered: Yes No Colors___________________________________ Fur: Short Medium Long
Guardian Name_________________________________________________ Have you been to FACE before? Yes No
Address____________________________________________ City__________________________ Zip Code___________
Phone(1)___________________ Phone(2)___________________ E-mail Address____________________________________
Have we seen this cat before?_________ Do you have other pets at home?_________ Is he/she: indoors outdoors both
How did you hear about FACE? (circle) Family Friend Internet Phonebook Other
ALL CATS MUST BE IN A CARRIER OR SECURE BOX!
Please answer the following as completely as possible. The answers provided will allow us to better
serve both you and your cat. Should you require assistance, please ask a representative.
How long have you had this cat? ___________________________________
Is he/she neutered? (circle) YES NO
(For female cats) Is it possible that she may be pregnant? (circle) YES NO
Does he/she seem healthy to you? YES NO If you answered NO, please explain: ______________
_________________________________________________________________________
Approximate date of last vaccines __________________
Has your cat bitten anyone in the last 10 days? (circle) YES NO
Has your cat ever had a reaction to vaccines? ________________________
Does your cat get carsick? __________________________________
How many other cats/dogs do you have at home? ______________________________
Where do your cats/dogs stay? (circle) INSIDE OUTSIDE BOTH
_________________________________ _______________
Client Signature Date