Rabbit History Form
RDVM info
Date
/
Month
/
Day
Year
Date
Name of Rabbit
Breed
Sex
Pet Rabbit/Breeder?
Age
Length of time owned
Where acquired? (Breeder/Pet Store/Other):
How often is rabbit handled? (Daily/Occasionally/Never)
Character of Feces
Husbandry
Housed Indoors/Outdoors?
Is rabbit allowed to roam free in the house?
Yes
No
Where is cage located?
Type of Caging
Size of Caging
Galvanized?
Yes
No
Cage Substrate?
How often is caged cleaned?
What type of disinfectant is used when cleaning cage?
Nutrition
Type of food offered:
Pellets? Yes/No; if yes, what brand?
Amount fed/frequency
Hay? Yes/No; if yes, what brand?:
Amount fed/frequency
Supplements offered and frequency?(i.e. fresh grass, carrots, lettuce, etc. )
Water source?
How often is water changed?
Any other pets? Yes/No; if yes, specify?
Do other pets interact with rabbit? Yes/No
Any other rabbits? Yes/No; if yes, specify:
Are rabbits housed together or singly?
If not housed together, where are other rabbits located?
Any new additions to the rabbit population? Yes/No; if yes, specify:
Past Medical History/Problems:
Current Presenting Problem:
Duration of Complaint:
Submit
Should be Empty: