This is an example of a Cat Profile containing contacts and medical records that a member can enter online.
See an example of the Dog Emergency Profile.
Cat Information
Cat’s Name / Owner’s Name:
TABITHA – Cat / Lynn Smart
Telephone / Alternate
+1-555/555-1212 – +1-555/555-1214
Birth Date
4/5/2008
Breed – Blood Type – Gender
American Shorthair – B – female
Height – Weight – Coat Color – Eye Color
0' 10''– 8 lbs. – Black and White Van – Copper
Inoculations
Rabies Panleukopenia Rhinotracheitis Calicivirus
Other Treatments
Feline Leukemia
Cat Registration No. / Date
C3672-00231 7 7 2008
Other Registration No. / Date
Collin County 3623-7634 07 06 2008
Clinic-Hospital / Pet No.
Pet Health Clinic C06738
Microchip Provider / No.
Chip Data 7368 2432 1234 876
Apartment Registration / No.
Willow Creek Apt. C12937
Medical & Item Alerts
Medical Alert Condition:
Medical Alert
Please be advised that has Epilepsy
Medicine
Phenobarbital
Contact / Telephone
Lynn Smart / +1-555/555-1212
Alert Note
Seizures under control with medicine
Emergency Contacts
Name:
Sam Fenton
Relationship / Contact Type
Friend — 1
Telephone
1-555/111-2222
Alternate Telephone
1-/-
Work Telephone
1-/-
michael@mcgrathdesign.com
Address:
4225 Rosemeade Road
City/State/Zip/Country
Carrollton, TX 75076 – USA
Veterinarian Profile
Veterinarian Name:
Justin Browne, DVM, – Primary
Specialty
General Behavior
Telephone
1-555/555-1212
Alternate Telephone
1-/-
michael@mcgrathdesign.com
Clinic - Hospital Name
Pet Health Clinic
Address:
4800 Grande Street
City/State/Zip/Country
Dallas, TX 75220 – USA
Veterinarian Name:
Rebecca Millstone, DVM
Specialty
Internal medicine
Telephone
1-555/555-1232
Alternate Telephone
1-/-
reb.m@millstone.com
Clinic - Hospital Name
Shilo Veterinarian Clinic
Address:
3267 Shilo Road
City/State/Zip/Country
Garland, TX 75002 – USA
Pet Pharmacy Data
Pharmacy Name
PetPharm
Telephone
1-555/555-1212
Address:
7620 Montfort Lane
City/State/Zip/Country
Dallas, TX 75248
Pet Medicines
Medication:
Dichlorophene Toluene
Prescription # / Expiration Date
364532 – 4 / 2018
Dosage / Frequency
120mg – daily
Pet Name / Pharmacy Name
Tabetha / PetPharm
Notes:
Administer with 160mg of Toluene for six days
Recent Treatments
Condition Treated:
Arthritis
Practitioner / Treatment Date
Richard Durbin – 4 / 9 / 2018
Facility Name
Pet Health Clinic – Arthritic Pain Injection
Telephone
1-555/555-1212
Address:
6630 Lawnwood St.
City/State/Zip/Country
Frisco, TX 75075 – USA
Recent Treatment Notes:
Spinal disc deterioration
Surgeries & Procedures
Surgery:
Neutering
Surgeon / Surgery Date
David Blake – 5 / 7 / 2018
Facility Name
Pet Health – Clinic
Telephone
1-555/555-1212
Address:
6630 Lawnwood St.
City/State/Zip/Country
Frisco, TX 75075 – USA
Notes:
No problems after procedure
Allergies
Health Insurance
Insurance Company
Petassurance – Primary Health Plan
Plan Name
CatHealth
Subscriber Number / Group Number
653728 38372 /
Policy Members
Insurance Card Number / Card Date
– 0 / 0 / 0
Payer ID Number / Effective Date
– 0 / 0 / 0
COPAY – O Visit / Spec OV / Urg Care / ER
/ / /
RX COPAY – Tier 1 / Tiew 2 / Tier 3
/ /
Consumer Telephone
- / -
Provider Telephone
- / -
Health Insurance Notes:
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