Exotic Husbandry Form
Street Address Line 2
State / Province
Postal / Zip Code
Length of time owned?
Where did you acquire pet?
How often is pet handled? Daily, occasionally, never?
Type, size and location of cage?
What is used to clean it and how often?
Who is housed with pet?
Other pets in house?
If dogs are present, have they been vaccinated for Bordetella?
Any new additions to the pet population?
If yes, specify
Were new pets quarantined?
If yes, length of time and how?
Is pet eating well?
Is pet drinking well?
If no to either, please describe:
Do you offer Hay? If yes, brand, amount fed, frequency
Pellets? If yes, brand, amount, frequency
Seed mixture? If yes, brand, amount, frequency
Fresh fruit/Vegetables? Type, amount, frequency
Other food items? Brand, amount, frequency
Supplements? Brand , amount, frequency
Water source and how often is it changed?
What type of visit is this?
If sick/behavior changes please specify:
How long has this issue been going on and are other pets having this issue?
Describe pets Feces:
Is pet urinating normally?
Is pet defecating normally?
If no to either, please explain:
Any recent travel? If yes, where and when?
Any known medication reactions? If yes, explain:
Should be Empty:
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