(309) 383-2356
myfamilypetvet@mtco.com

Book Appointment

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(309) 383-2356
myfamilypetvet@mtco.com

(309) 383-2356

Book Appointment

Home
About Us
Services
Resources
Careers
Order Online
Contact

Cat History Form

Save time during your appointment! Complete your required forms online from any device before your visit.

Cat History Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Name *

First

Last

Email *

Patient Name

How is your cat today?

What is the reason for your visit?

Consultation about disease
Second opinion
Health check
Vaccination and prevention
Questions about spaying or castration
Other

Please specify:

Living Environment

Stays home
Only goes out on the deck/balcony/patio
Goes out with owner
Free to go out
Outside
Not the owner

If you selected goes outside, please let us know the amount of time spent outdoors daily:

Food Menu: (In detail)

Only dry food
Only wet food
Dry and wet food
Other

Please list the specific food you are feeding your cat:

If you provide your pet with snacks, please provide details about the amount and types of snacks.

Was your cat vaccinated?

Panleukopenia (P)
Calicivirus and Herpesvirus (RC)
Leukemia (FeLV)
Rabies
Chlamydia (Ch)
Other
Don't know in detail

When was the last vaccination?

Please provide the date of the last vaccination.

Have you treated your cat against parasites?

Fleas/ticks/mites
Heartworm/Lungworms
Gastrointestinal worms
No

Does your cat have allergies, or overreact to certain vaccine/medicine?

amount you the

Has your cat had a serious illness/injury?

Do you have any requests for treatment?

My first priority is saving time and making as few visits to the hospital as possible.
I want to clarify procedures and fee for treatment before doing it.
I want to check my cat's health, not only treat it for sickness.
I am interested in state-of-the-art treatment for my cat.
I want to have information about disease prevention.

Please write down any other request:

About your cat's story

Please share any other information about your cat (charming points, etc.)

cat with vet

Ready to Visit?

We take pride in delivering outstanding veterinary services to the pets and families of Germantown Hills, Low Point, Metamora, Washburn, Eureka, Peoria Heights, East Peoria, Peoria, and the surrounding communities. We ensure that your cherished companion receives the utmost care and treatment possible. Click the button below to arrange your appointment.

Book Appointment

Have a Question?

Please complete our online form, and a member of our team will get back to you as quickly as possible.

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Location

511 Ten Mile Creek Rd.
Germantown Hills, IL 61548

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Contact Information

Phone: (309) 383-2356
Email: myfamilypetvet@mtco.com



Hours

Mon-Fri: 7:30 AM – 5:30 PM
Sat: 8:00 AM – 12:00 PM
Sun: Closed

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