Disease Risk Assessment – Cat"*" indicates required fieldsOwner’s InformationName* First Last Phone*Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Pet's Information In an effort to keep your pet as healthy as possible, we want to provide you with some information that can help us decide the best vaccination protocol and schedule for your cat. The core vaccinations we provide on a routine basis are an FVRCP combination vaccine {Rhinotracheitis (Herpes), Calicivirus, & Panleukopenia (Feline Parvo)} and Rabies. The FVRCP vaccination is given as a series for kittens and then every 1-3 years as your cat ages. Rabies is given at 4 months of age, then boostered yearly. (A new non-adjuvanted Rabies vaccine has been developed which must be given yearly, but it is less likely to cause tissue inflammation and reactions; thus, it is safer for your cat). If your pet will be traveling overseas (especially to Japan) or outside the continental U.S., this new Rabies vaccine may not be accepted by some countries - please let us know if this is a possibility. In addition to the core vaccinations, there is a non-core vaccination that may be given if your pet is considered at risk for the disease.Non-core vaccine: Feline Leukemia -This is a virus that suppresses your cat’s immune system. There is no cure for feline leukemia. It is transmitted by a mother cat to her babies if the mother is infected, or by bite wounds from a cat infected with the virus (e.g. stray cats). This vaccine is recommended if your cat spends time outdoors (especially if it is known to fight with other cats), interacts with FELV-positive cats in your household, or is around other cats that go outdoors. If you are unsure if your cat will have access to the outdoors, this vaccine should be considered. We recommend testing all newly acquired kittens/cats for FELV and FIV. When given this vaccine at the same time as other vaccines your cat may experience fever, lethargy, and decreased appetite. Because of this, we recommend giving this vaccine as a separate vaccination (usually no sooner than 3 weeks from the other vaccines). In rare cases, there have been tumor formations at the site of this vaccination (it is believed to be secondary to an inflammatory response caused by a reaction to its carrier or adjuvant.) Although this incidence is quite rare, it must be factored into your decision.Please answer the following questions for*(write cat’s name)1. Goes outside unattended.* Yes No2. Is in contact with cats that go outdoors* Yes No3. Has contact with unvaccinated cats.* Yes No4. Has contact with a known leukemia positive cat.* Yes No*Please inform us at any time if your pet’s lifestyle or environment changes, so that we may review their current vaccination schedule and advise you of our recommendations. Signature*Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
