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This Old Cat, P.O. Box 320, Honeoye, New York 14471-0320 USA
local phone 585-919-6557  toll-free phone 1-866-388-4707  toll-free fax 1-866-343-2737
email thisoldcat@rochester.rr.com      www.TheSunshineHome.com

TEXT LONG-TERM CARE APPLICATION
(type your answer on the line after each item)

***************** PART B *******************************
Complete this Part B for EACH CAT, using separate forms for 
each in a multi-cat household.
*********************************************************

Your Name:


Today’s Date:


Cat's Name:


Cat's Date of Birth:


Nickname(s) for this Cat  (if any):


Cat normally wears  (Collar,  Tag or  Neither):


~RABIES VACCINATION~          
	Rabies Date Last Done:
	
	Rabies Next Due Date:
	

~DISTEMPER VACCINATION~ 
	Distemper Date Last Done:
	
	Distemper Next Due Date:
	

OTHER VACCINATIONS? (Please specify type & date last done and date next is due):


~FELV/FIV TEST (test should be done no more than 3 months prior to arrival at The Sunshine Home) ~
	Most Recent Test Date:
	
	Test Results (Negative or Positive):
	

NOTE: We will need proof of flea treatment, ear mite check and fecal testing -- all done by a veterinarian no more than 30 days prior to arrival at The Sunshine Home -- otherwise this will done immediately after they arrive at your expense.  

Hair length  (S=Short,  M=Medium or L=Long):


Breed (DM=Domestic Mix  or  P=Purebred please specify):


Gender (M=Male or F=Female):


Neutered/Spayed? (Yes or No --  and if yes, at what age):


Declawed? (Yes or No --  and if yes, at what age):


Microchip Brand & Number (None if not chipped):


Tattoo?(Yes or No --  and if yes, tattoo location):


On Average, How Many Hours Does Cat Go Outdoors?


Color(s) of Fur:


Any Special Markings?:


Color of Eyes:


Any Known Allergies?:


On a scale of  1 to 10  with   0 =”I don’t know”,   1=“not good” and   10 = “very good”,
	How is this cat with Dogs?:
	
	How is this cat with Other Cats?:
	
	How is this cat with  Human Visitors?
	

Dry Food(s) Cat Eats:


Wet Food(s) Cat Eats:

	How Much and How Often?:
	

Cat Litter Used:


Cat's Approximate Weight:

	Is weight up, down or steady in past year?:
	

Things Cat Enjoys:


Things Cat Dislikes:


Describe Cat's General Personality:


Any Past Medical Conditions?  (please explain):


Any Known Medical Conditions?  (please explain):


Any Other Comments?



============END OF FORM================
Rev4-08022009
(c) Copyright 2009 This Old Cat, All Rights Reserved