Intake Form

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Have you already contacted Max? If not, email max@felinefriendsofsammamis.org *

Your Name *

Your Email *

Date of Intake / Transfer *

Cat Name (if not known, Cat 1, Cat 2, etc or collar color) *

Sex *

Fur Length *

Breed (optional)

Approximate Age *

Weight (in pounds) or approximate *

Color *

Any special features / markings (polydactyl, etc)

Microchip number (if available)

Spay / Neuter *

Rabies Vaccine – DATE. Email Rabies Certificate!

Viral test (FeLV/FIV) – date and results

FVRCP – list dates

DeWorming Treatment

DeWorming Date

Flea Treatments

Flea Treatment Date

Ringworm treated or noticed – Location of ringworm

Other medical issues, concerns:

Socialization

Food: what has kitty been eating?

Previous Situation / Location

Vet Records – List Vet/Clinic Name and City

History; any additional information we should be aware of:

Location/Placement once transferred to FFoS

FFoS Foster Name

Feline Friends of Sammamish

16515 SE May Valley Road, Renton, WA 98059

All Volunteer Organization, 501(c)3, EIN: 84-4524017

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