Small Mammal History Form (OR)

Please fill this out before you bring your small mammal into our office. This will speed up the intake process and let us get to work sooner.

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General History

Your Name (First and Last) *

Your Pet's Name *

Color

Date of Birth or Approximate Age

Gender

Where and when did you acquire your pet?

Do you have any other pets? If yes, please specify:

Housing

Please describe what type of cage/environment your pet lives in:

What kind of bedding do you use on the bottom of the cage?

How often is the cage/environment cleaned?

Method/frequency of cleaning food and water dishes:

Describe any cage accessories (toys, bowls, etc):

Has your pet's environment (cage, toys, etc) changed recently? If yes, please describe:

If your pet is a chinchilla, do they get dust baths? If yes, what frequency?

If your pet is a ferret, do they use a litterbox?

Diet

What foods do you feed your pet?

Do you give any vitamin supplements? If so, what type?

What, if any, treats are offered? How often?

Any recent diet changes or new foods? If yes, please describe:

How is water offered (sipper bottle, bowl, etc)?

Medical

Please list any previous medical problems:

Has your pet ever been hospitalized or had surgery? Please describe:

Have there been any changes in your pet's urine or defecation? Please describe:

Does your pet have any behavior problems? Please describe:

Please list any current or recent medications:

Has your pet been vaccinated? When and where?

General

Is your pet bathed or groomed regularly?

Does your pet get nail trimming?

Do you have pet insurance?

Any other comments or information we should know?

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