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Small Mammal History/Husbandry Worksheet
Please answer the following questions as accurately as possible. The more information you provide, the better we can help you and your pet. We realize this is long and appreciate your time and efforts.
Date
*
First Name
*
Last Name
*
Pet Name
*
Pet Birthdate
*
Pet Species & Breed
*
Pet Sex
*
Has your pet been spayed (females) or neutered (males)? when?
*
General Information
How long have you had your pet?
*
Where did you acquire your pet?
*
Is your pet used to being handled?
*
Are you comfortable:
*
Are you comfortable:
Picking up your pet
Grooming
Trimming nails
Giving medications
Medical Information
Has your pet had any vaccinations in the past or recently?
*
Has your pet had any vaccinations in the past or recently?
A
Yes
B
No
If yes, what and when?
*
Chief complaint/reason for today’s visit?
*
How long have you noticed the problem? ie: when did it start?
*
Is the problem getting:
*
Is the problem getting:
A
Worse
B
Better
C
Same
To your knowledge, does your pet have any history of disease or illness?
*
Have any other pets been sick or died in the past 3 months? If yes, please describe:
*
Has your pet been to another veterinarian? If yes. When? and Where?
*
Have you noticed any of the following signs? (check all that apply)
*
Have you noticed any of the following signs? (check all that apply)
Behavior change
Lethargy / change in exercise
Nose or eye discharge
Sneezing
Increased breathing rate or effort Change in voice / vocalization
Vomiting / regurgitating
Change in stool appearance or amount
Diarrhea
Change in urine / color / volume
Lameness / weakness
Change in thirst
Change in appetite
Change in weight
Scratching
Fur loss / abnormalities
Skin lumps (masses)
Have you tried any over the counter remedies or supplements?
*
Is your pet taking any medications? If yes, please describe:
*
Housing Information
Where does your pet live?
*
Where does your pet live?
A
Inside
B
Outside
C
Cage
D
Free in home or designated room
Does your pet have a cage or house mate?
*
Does your pet have a cage or house mate?
A
Yes
B
No
Have you acquired any new pets in the past 3 months? If yes, what/when?
*
What type of cage is your pet housed in?
*
What type of cage is your pet housed in?
A
Aquarium
B
Plexiglas
C
Wire
D
Wooden
E
Pen
F
Hutch
How much time does your pet spend outside it’s cage?
*
How much time does your pet spend outside it’s cage?
A
It roams free and does not have a cage
B
Daily
C
Weekly
D
Never
Does your pet chew on anything outside of it’s cage? If yes, please describe.
*
What is in the cage?
*
What is in the cage?
Hide areas
Exercise Wheel
Tunnels
Toys
What type of substrate do you use? Check all that apply
*
What type of substrate do you use? Check all that apply
Shavings
Care Fresh or other recycled paper bedding
Pellets - Wood, Paper
Kitty Litter
Fleece or other fabric
How often do you clean your pet’s cage?
*
How often do you clean your pet’s cage?
A
Daily
B
Weekly
C
Monthly
What do you use to clean it?
*
Diet Information
Multiple Choice
*
Multiple Choice
A
Pellets
B
Species appropriate seed mix
C
Hay
D
Fresh foods
E
Treats
Please list brands and types (for fresh foods and hay) to the best of your ability
*
Do you give your pet vitamins?
*
Do you give your pet vitamins?
A
Yes
B
No
Do you give your pet Supplements?
*
Do you give your pet Supplements?
A
Yes
B
No
How much do you feed your pet?
*
How much do you feed your pet?
A
Measured amount
B
Free Choice ie: food always available
*
How often do you change the food?
*
How often do you change the food?
A
Daily
B
Weekly
How is water offered?
*
How is water offered?
A
Bottle
B
Bowl
How often do you change the water?
*
How often do you change the water?
A
Daily
B
Weekly
How do you clean the food and water “dishes”?
*
How do you clean the food and water “dishes”?
A
Rinse only
B
With soap, by hand
C
Dishwasher
Submit