Small Mammal Exotic History Form

Date

Name

First Name Last Name

Pet's Name:

Species and breed (if known)

What is the primary reason for your visit and what concerns do you have today?

Has your pet received any treatment at home? What was given, and how long was it given?

Has your pet been seen at another clinic? If so, please list the clinic name so we can call for records.

The following questions are regarding the husbandry, or at home living environment for your pet. This information helps us get a full picture of what may be going on with your pet.

How old is your pet?

How long have you had your pet?

Where did you get your pet from?

What is your pet housed in (i.e. a hutch,plastic bottom/wire top cage, exercise pen, etc.)?

Please email or upload pictures of your pet’s enclosure.

Browse Files

Where in the house is your pet primarily living (living room, garage, bedroom)?

Is the enclosure near vents/windows/ outside walls?

YesNo

What substrate (bedding) do you use in the enclosure?

How frequently do you spot clean and fully clean the enclosure?

How often do you clean the food and water dishes?

What do you use to clean the enclosure and dishes?

What kind of hides and enrichment is in the enclosure(i.e. toys, chews, blankets, hammocks, etc.)?

Is your pet litter box trained?

YesNo

Does your pet drink from a water bowl or bottle?

What do you primarily feed your pet (i.e. hay,pellets, fruits/veggies)?

How much and how often do you feed your pet?

What treats do you give your pet? How often?

For carnivores: Do you feed whole prey or raw diets?

Do you use vitamin or mineral supplements? If so what kind and how often?

What is the maximum and minimum temperature in the enclosure?

How many hours of daylight and nighttime does your pet get each day?

Are there any other pets in the house?

How often does this pet interact with the other pets?