Exotic Husbandry Form
Full Name
*
First Name
Last Name
Pets Name
First Name
Last Name
Pets Sex:
Male
Female
Spayed/Neutered
Age
Color
Species:
Rabbit
Rodent
Guinea Pig
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
E-mail
example@example.com
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?
Toys offered?
Litterbox offered?
Who is housed with pet?
Alone
Cage mate
Other pets in house?
If dogs are present, have they been vaccinated for Bordetella?
Any new additions to the pet population?
Yes
No
If yes, specify
Were new pets quarantined?
Yes
No
If yes, length of time and how?
Is pet eating well?
Yes
No
Is pet drinking well?
Yes
No
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?
Wellness
Sick
Behavior
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:
Submit
Should be Empty: