Ferret History Form

Ferret History Form

An accurate history of your pet is extremely important. We would appreciate your cooperation in providing us with the following information.
Your Name

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
Pet's Name
Gender

Female Male
Spayed/Neutered

Yes No
Date of Birth
Date Acquired
Source (breeder/pet store/previous owner)
Number of Previous Owners
Other states or countries in which your pet has lived
Cage Type (please include Dimensions, Lining/Substrate)
How often and for how long do you let your pet out of his/her cage, and is your pet monitored at all times while out?
At what temperature is the enclosure maintained
Please indicate any recent changes to the enclosure
Please describe any furnishings or objects in the cage
Please list all pets in your household. Include Species, Age and if he/she is housed in cage with patient
Have you changed your pet's food recently?

Yes No
If yes, please specify when and why
Do you provide any of the following?

Kibble Live/Frozen Prey Fruit Treats
Please list brand names and types for the choices above.
Amount actually consumed by pet
How often given
Has your pet been spayed/neutered

Yes No
If no are you planning on breeding your ferret

Yes No option
How many litters has your pet had/sired previously
When was the last litter
Please list any health problems with the kits
How many kits
Please list any previous conditions problems or operations. Must include the date it began, a description of the problem/procedure and if it is resolved or on-going.
Is your ferret here for

A well pet check-up (no major health concerns) If so please proceed to the last question of this questionnaire A sick/unhealthy evaluation with health concerns
Is your pet's general activity level

Normal Decreased Increased
Is your pet's appetite

Normal Decreased Increased
Have you noticed any of the following

Weight loss, weight gain, discharge from the eyes or nose Increased breathing rate or effort A change in the droppings Abnormal skin color or shedding Parasites on the skin or in the feces Weakness
Have you used any medications from a pet store

Yes No
If yes, specify
Please tell us how your ferret has been doing recently, as well as any problems he/she has been having
Has your ferret been seen by another veterinarian for any of the current problems?

Yes No
If yes, please list tests performed and medications given
Is there anything else you would like done today? (nail trim, i have questions, etc...)
Should be Empty: