Name: Veterinarian
Brand: Village Square Veterinary Clinic

Date

Owner's Name

Owner's Email

Patient

The Village Square Veterinary Clinic uses this Risk Assessment to determine which vaccinations your pet should receive. It is not our belief that every animal needs to receive vaccinations for every disease if their lifestyle does not put them at risk for those diseases. Please answer every question to help us provide the best possible protection for your pet. Should you have any questions, please do not hesitate to ask.

Have unsupervised time outside?

Yes

Board

Yes

Have access to a ground floor screened porch/patio?

Yes

Visit other cats either at your home or someone else’s?

Yes

Participate in activities where they come in contact with other animals? (i.e. showing or breeding)

Yes

Have a history of any serious illness? If yes, what?

Yes

Have a history of any kind of reaction to vaccines? If so, what kind?

Yes

Have access to food/water outside where other animals do too?

Yes

Do you have contact with other animals with or without your pet?

Yes

Do you travel with your cat?

Yes

Do you feed the same brand of food consistently? Which brand?

I accept the recommendations for vaccination that Village Square Veterinary Clinic deems best for my pet.

I decline the vaccinations that Village Square Veterinary Clinic recommends except for

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Feline Risk Assessment Form

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