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This Old Cat, P.O. Box 320, Honeoye, New York 14471-0320 USA
phone  585.919.6557  toll-free fax  1.866.343.2737
email  TheSunshineHome@ThisOldCat.com www.TheSunshineHome.com

	Long-Term Care Application (2021 Rev. A)
	PART B, CAT'S INFORMATION

[Complete this Part B for your cat, using additional Part Bs for each cat in a multi-cat household]

Today’s Date:

Your Last Name:

Cat's Name:

Nickname(s) I have for this cat (if any):
  
Cat's Date of Birth:

Color of Eyes: 

Color(s) of Fur:

Distinguishing Markings (if any):
  
Cat's most recent RABIES Vaccination - 
	Date Last Done:
	Date Next Due:
Cat's most recent FVRCP (“Feline Distemper”) Vaccination - 
	Date Last Done:
	Date Next Due:
 
Other Vaccinations (please specify type of vaccination and dates last done & next due):

Most Recent FeLV/FIV Test Date:
	Test Results:

Please Note: We ask for documentation from your vet showing the FeLV/FIV test was done within 90
 days prior to the cat's arrival at The Sunshine Home at This Old Cat, also proof of flea treatment, ear
 mite check and fecal testing done by your veterinarian within 30 days prior to arrival, otherwise this
 will done at your expense upon the cat's arrival.

Breed (Domestic mix or Purebred breed name):

Hair length (Short, Medium or Long):

Gender (Male or Female):
 
Neutered/Spayed? (Yes or No):
   *If yes, at what age:

Declawed? (Yes or No):
   *If yes, at what age:

Microchipped? (Yes or No):
   *If yes, Brand & #:
Tattooed ID? (Yes or No):
   *If yes, Location of tattoo:

Cat normally wears a Collar (Yes or No):

Any known allergies? (Yes or No):
   *If yes, please specify:

On an average day, how many hours does the cat spend Indoors:
On an average day, how many hours does the cat spend Outdoors:

How long have you had this cat?:
Where did you get it from?:

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 other cats?:
   How is this cat with human visitors?:
   How is this cat with visits to the veterinarian?:

Dry food(s) cat eats:

Canned food(s) cat eats:
   How much canned food & how often?:
  
Cat's approximate weight:
   Is weight up/down/steady in past year?:

Cat litter used:
  
Number of litter boxes in home:
   Type of litter box preferred (Open or Covered):

Things Cat Enjoys: 

Things Cat Dislikes:  

Describe Cat's General Personality:  

Any Past Medical Conditions? (please explain):

Any Current Medical Conditions? (please explain):

Any Other Comments?:


     [END OF FORM]

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LONG-TERM CARE APPLICATION 2021 Rev. A
(c) Copyright 1998-2021 This Old Cat, All Rights Reserved
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