Date
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Patient Information |
Species:
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Gender: :
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Spayed/neutered: :
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Date of Birth:
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Date acquired:
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Source: :
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Number of previous owners:
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What states and countries has your pet lived in?
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Environment |
Is the animal kept :
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Describe the cage enclosure- type, size, objects in cage (dust bathe, toys)
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Is the animal kept in a cage with other animals? :
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If answered "yes" to the previous questions, how many cage mates are there?
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What are the sex of the cage mates?
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Are the cage mates spayed/neutered?
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Please list all of the other pets in your household:
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Has there been any new pets (last 6 months) placed in the animal's cage?
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How much time does your pet spend outside of the cage?
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My pet is supervised outside of the cage: :
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Does your pet chew on carpet or other objects/materials when outside the cage?
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List recent changes in the environment, if any:
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Diet |
Food consumption
What amount of your pet's diet consists of the following (please describe what the animal actually eats, not what is offered): |
Amount of hay (timothy, alfalfa, atc,)
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Amount of pellets (timothy, alfalfa, etc,..)
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Amount of seeds (types/brand)
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Amount of vegetables (types)
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Amount of fruits (types)
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Other:
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Amount and type:
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How often do you change your pet (brand and amount)?
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What, if any treats, do you give your pet (brand and amount)?
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Do you supplement your pet with any vitamins?
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Is the food or water supplemented with vitamins?
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Brand and frequency?
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Describe any recent change to your pet's diet.
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Reproductive |
Has this pet been bred before?
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If yes, how many times?
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What was the size of all previous litters? Was the litter healthy?
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Do you plan on breeding this pet in the future?
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Your pet is here for a:
Well pet check up
Sick check up
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If your pet is sick, please describe the sign and how long your pet has been showing these signs:
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Your pet's activity level is: :
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Your pet's appetite is: :
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Have you noticed any of the following: :
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Previous Conditions |
Has your pet had any previous conditions, operations (including dental or gastro problems)?
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Miscellaneous |
Is your pet currently on any medications?
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Has your pet been on any medications recently? If yes, please list them.
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Anything else you would like done today?
Nail trim
Other
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Have questions about:
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