Rabbit History Form

Date

Admitting Clinician

Appt. Time

Name of Rabbit

Breed

Sex

Age

Background Information:

Length of time owned

Where did you acquire your pet?

BreederPet StoreOther

Character of Feces

Husbandry:

Housed Indoors/Outdoors?

How often is your Rabbit handled?

DailyOccasionallyNever

Is your rabbit allowed to roam free in the home?

YesNo

Where is cage located?

Galvanized:

YesNo

Type of Caging

Size of Caging

Cage Substrate?

How often is caged cleaned?

What type of disinfectant is used when cleaning cage?

Type of food offered:

PelletsHay

What brand of pellets?

Amount fed/frequency

What type of Hay?

Amount fed/frequency

Supplements offered and frequency?(i.c fresh grass, carrots, lettuce, etc... )

Water source?

How often is water changed?

Any other pets? If yes, specify

Do your pets interact with the rabbit?

YesNo

Specify any other rabbits

Are rabbits housed together or singly?

If not housed together, where are the other rabbits located? If yes, specify

If yes, specify

Past Medical History/Problems:

Current Presenting Problem:

Duration of Complaint: