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?

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ENERGY: On a scale of 1 to 5 where 1 is hardly moving and 5 is normal playfulness, where does your foster rate?

APPETITE: On a scale of 1 to 5 where 1 is not eating at all and 5 is normal appetite, where does your foster rate?

THIRST: On a scale of 1 to 5 where 1 is not drinking at all and 5 is normal thirst, where does your foster rate?

HAIR LOSS:
Any hair loss?
Yes
No

If yes, list all the areas where hair loss is apparent.
Paws
Face
Top of Head
Back
Tummy
Tail
Other areas of hair loss:

Describe the areas where hair loss is apparent
Flaky/scabby
Smooth
Fuzzy/hair growing back

When did the hair loss start?

OTHER:
Please note any other symptoms that you have noticed with this foster animal

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