Prairie Lane Veterinary Hospital - Exotic Animal History Form

Exotic Animal History Form

Thank you for filling out our Exotics History Form.This information will help our team better serve your pet.
Client Information
Clients Name*

First NameLast Name
Patient's Name*
Current Illness (write "none" if no current illness)*
Current Medications (write "none" if no current medications)*
Diet
Current Diet*
How Much?*
How Often?*
Brand of Food Used*
Vitamins*
Treats*
Water
Water (select all that apply):*

BottleBowl
Water Changed (times/day)*
Housing
Location*

OutdoorsIndoorsBoth Outdoors and Indoors
If Indoors, what specific location?*
Enclosure Made Of*
Dimensions*
Bedding Used*
Brand of Bedding Used*
Other
Exercise
Exercise*
Lighting
Do you use lighting for your pet?*

YesNo
Current Lighting*
Location Relative to Pet*
How Many Hours Daily*
How Often Bulbs Changed*
Time Spent Outside*
Temperature/Humidity
Does your pet require temperature control?*

YesNo
Day*
Night*
Basking Area?*
Heat Source*
Humidity Current %*
Mist/Soak?*
Other
Other information you'd like to provide:
Signature*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty:

Exotic Animal History Form