Please complete this form to request medical assistance for each sick C.A.T.S. foster animal:
Foster's First Name*
Foster's Last Name*
Email*
Phone Number* (cell preferred)
Can you send/receive text messages at this number?* Yes No
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Dog/Cat's Name*
Male or Female* Male Female Can't Tell
Dog/Cat's Age*
Dog/Cat's Weight*
Dog/Cat's Description* (color, pattern, breed)
Is this animal sharing food/water bowls with any other animals? Yes No
If a cat, is it sharing a litterbox with any other cat(s)? Yes No
Have you given any medication to date? Yes No
If yes, what, how much & when did you start?
FIRMNESS: On a scale of 1 to 5 where 1 is completely liquid and 5 is normal/firm, where does your foster rate?
COLOR: On a scale of 1 to 5 where 1 is yellow and 5 is normal/brown, where does your foster rate?
SMELL: On a scale of 1 to 5 where 1 is "evacuate the house" and 5 is normal poop smell, where does your foster rate?
BLOOD: Any blood in the stool? Yes No
If yes, how much? Slight Marbled throughout Puddle of blood
WORMS: Any sign of worms? Yes No
What is the date that the diarrhea began?
CHANGES IN DIET: Have you changed his/her diet? (start from 2 weeks before symptoms through now) Yes No
What is the date that you changed the diet?
What EXACTLY were the changes in diet?
CHANGES IN ENVIRONMENT: Has your foster been recently exposed to a new animal or a new enviromnent? Yes No
Any new "stresses" in your foster's life? If yes, what EXACTLY
OTHER: Please note any other symptoms that you have noticed with this foster animal