top of page

Feline Registration Form

Bayshore Veterinary Clinic of L’Anse

438 Main Street

L’Anse, MI  49946


Feline Patient Registration Form


Name of Owner ___________________________________________________________

                                 Last                                             First                                     Middle


Home Address ___________________________________________________________



                                  City                                             State                                   Zip

e-mail address_____________________________


Drivers License/SS# ______See Attached______ (This information is needed in case of   anesthetic or prescription of certain controlled medications)


Name of Spouse/Partner _________________________ Home Phone _______________


Other Phone___________________________ (business, employment, relative, neighbor)


Referred by Whom _____________________ Previous Veterinarian? ________________


Animal Information


Name ______________________ Breed ______________________ Color ____________



Birth Date _______________    Male           Neutered            Female             Spayed


Date of Last:

            1. Distemper Vaccination (FVRCPC) ____________________________________

            2. Rabies Vaccination ________________________________________________

            3. Feline Leukemia Vaccination (FELV) __________________________________

            5. Has your cat ever been tested for Feline Leukemia? ______ Results _________

            6. Has your cat ever been dewormed? ______ When? ______________________

7. Last Stool Exam (for Intestinal Parasites) _______________________________


Are there any chronic medical problems of which we should be aware? _______________

            Please explain ______________________________________________________


Is your cat currently on any medications? (If so, please list them) ___________________



Your cat is INDOORS __________ % and/or OUTDOORS __________ %


Do you have any other cats? _____ How many? _____ Dogs? _____ How many? _____


What brand of cat food do you currently feed? __________________________________


Form of Payment

                              Cash _____ Personal Check _____ Visa/MasterCard/Discover _____


I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet.  I assume responsibility for all charges incurred in the care of this animal.  I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment.


Please sign to consent to treatment: _____________________________ Date: ____________


For Office Use: Identification Verified    Date_________  Initials_________

bottom of page