The Cat House Hotel®

DIABETIC FELINE BOARD AND CARE CONTRACT ADDENDUM 2011

1. How old is your cat? _________. How long has your cat been diabetic? ____________ (minimum 3 months).

2. Has your cat been “stable”, i.e., on the same insulin dosage and schedule for at least the last 3 months?

Dosage: _______________ Minimum/Maximum hours between doses: _________/_________

Name of insulin product (e.g. ProZinc®): __________________________________

The price for this service is $5 per injection within our normal hours of operation and $15 per injection outside our normal hours of operation.

3. Must your cat eat before or after the injection for proper insulin balance?

Cats are very much creatures of habit and do not deal well with change. Change can induce stress, leading to changes in eating habits and altering blood sugar levels. Out of concern for your cat, our policy is to care only for very stable cats. We are not certified vet technicians and do not have the background to assess and diagnose changes in diabetic cats which are unfamiliar to us.

4. Who is your cat’s vet-of-choice? _____________________________ Phone: _________________________

5. When did he/she last test your cat for blood sugar levels? ______________. Test result: ________________

(Results must be supplied IN ADVANCE OF CHECK-IN and may be emailed to us at FrontDeskCoworker@cathousehotel.com or faxed to us at 805-898-9168, if you prefer)

(We highly recommend that a glucose check is conducted before your kitty stays with us. we also require a current rabies vaccination and an FVRCP shot every other year.)

6. Does your cat have any other medication requirements? ________________________________________________________________________________________

________________________________________________________________________________________

7. By signing this form you confirm that you have provided the required blood test results, and directed your vet to talk with us and to release information about your cat to us and to others as we may require. And if we deem the cat is manifesting diabetic problems (either way), that you agree to pay for the vet service costs for whichever vet will review your cat, e.g., the 24 hr. CARE hospital, in the event we encounter an acute situation or your vet-of-choice is unable to see your cat.

8. You will supply your own insulin, needles, plus wet and dry foods to prevent disrupting your cat’s daily regimen.

Date: _____________

OWNER: ____________________________ CAT HOUSE HOTEL: _________________________

Emergency contact if you can’t be reached: ____________________________ Cell:________________________