Small Mammal History Form

Small Mammal History Form
Owner's Name

First Name Last Name
Pet's name
Date of upcoming appointment

Month Day Year
Date
Environment:
Where is your small mammal kept? *

Indoor Outdoor
Are they kept in a cage with other animals? *

Yes No
Have there been any new pets (within the last 6 months) been placed in this pet's cage? *

Yes No
What materials do you use to line the bottom of the cage? *
How long does your pet spend outside of the cage? *
Is your pet supervised when out of the cage? *

At all times Sometimes No
Does your pet chew on carpet or other object/materials when outside of the cage? *

Yes No Not sure
Please list any recent changes in the environment, if any:
Diet:

What amount of your pet's diet consists of the following? *

What types of seeds, fruits and veggies do you feed?
How often do you change your pet's food? *
What (if any) treats do you give your pet? (include brand and amount)
Do you supplement your pet's diet wType a questionith any vitamins or supplements? *

Yes No
If yes, please list by them by name:
Please describe any recent changes to our pet's diet:
Reproductive:
Has your pet been bred before? *

Yes No Unknown
If yes, how many times?
When was your pet last bred?

Month Day Year
Date
What was the size of the litter?
Was the litter healthy?

Yes No Some were, some were not
Do you plan on breeding in the future?

Yes No Unsure
What type of appointment is this for your pet? *

Well pet Visit Sick or have concerns
How is your pet's appetite? *

Normal Decreased Increased
How is your pet's activity level? *

Normal Decreased Increased
Have you notice any of the following? Please check all that apply

Weight loss Weight gain Discharge from eyes or nose Increased breathing rate or effort Change in droppings Increased thirst Decreased thirst Weakness
Any other problems or concerns?
Should be Empty:

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Environment: