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Small Mammal History Form
When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.
Full Name
*
Email Address
*
Pet's Name (first and last)
*
Species
*
Age (if unknown please state UNK)
*
Sex
*
Sex
A
Male
B
Female
C
Unknown
How long have you had your pet and where did they come from?
Does your pet live indoor or outdoor?
Does your pet live indoor or outdoor?
A
Indoor
B
Outdoor
Type and size of cage (ie. 20 gallon glass tank). If you have an unusual or home
made enclosure we encourage bringing pictures at the time of the appointment to
show the doctor!
Is your pet allowed to free roam around the house?
What type of substrate is used and what type of cage furniture is in the enclosure?
How frequently is the enclosure cleaned and what disinfectant is used?
What type of food is fed? Please list brands and list in order of frequency, main
portion of diet to occ. treat please!
How often and how much are you feeding your pet?
When was the last time your pet ate?
What type of water source does your pet have?
Is your pet housed alone or with any other small mammals?
If housed with other pets, are there any new additions to the group?
Has your pet had any prior medical problems? If so, please elaborate
What is the reason for your pet being seen today? If sick, please include duration of
sickness.
Do you have any specific questions
for the doctor regarding your pet? We look
forward to meeting your fuzzy little friend!
Submit