Client Name Email Patient Name Please list a phone number where you can be reached today What brand of food does your cat normally eat at home (if multiple brands, please list all)?Is your cat taking any medications at this time? Yes No Please list medication and dosage.Has your cat been exhibiting any coughing, sneezing, vomiting, or diarrhea? Yes No Please DescribeAre there any other health problems, questions, or concerns you would like addressed at this time? Yes No Please DescribeDental procedures for cats require sedation. Do you give Morrisville Cat Hospital consent to sedate your cat? Yes No Once the patient is under anesthesia Dr. Simpson will perform a complete dental exam. Occasionally she may find a tooth with significant dental disease that may warrant extraction. How would you like us to proceed? I authorize any necessary extractions and realize there will be additional charges for this, including pain medication and possibly antibiotics. I prefer to be contacted prior to any additional procedure(s). I realize that if I am not reached, nothing additional will be performed and this may result in the need for my cat to undergo another anesthetic event. I do not authorize any extractions or additional procedures at this time. Has your cat been microchipped? Yes No Unsure CommentsThis field is for validation purposes and should be left unchanged.
