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?

    EYES:
    Any discharge from the eyes?
    Yes
    No

    If yes, what color is the discharge from the eyes?
    Clear
    Red/Brown
    Yellow/Green

    NOSE:
    Any discharge from the nose?
    Yes
    No

    If yes, what color is the discharge from the eyes?
    Clear
    Red/Brown
    Yellow/Green

    MOUTH:
    Any sores on the tongue, mouth or in the throat?
    Yes
    No

    BREATHING:
    Have you noticed any of the following symptoms? (check all that apply)*
    Breathing through the mouth
    Sneezing
    Coughing
    Rasping/Labored breath

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