• New Patient (Current Client): Exotic

    Shady Brook Animal Hospital

  • Please enter your information so we can locate your account

  • Format: (000) 000-0000.

  • PET INFORMATION

  • Sex:*

  • OWNERSHIP

  • Was there more than one pet obtained?*
  • Was {petName} quarantined?*
  • Are there any other pets in the household?*
  • Were these pets added to the household after {petName}?
  • Were these pets quarantined?
  • Has {petName} had any previous testing, treatment, or vaccines?*
  • Is {petName} displaying any symptoms of illness or having any medical problems?

  • ENVIRONMENT

  • What type of environment does {petName} reside in?*
  • Where does {petName} spend most of their time?*
  • Does {petName} have availability of hide boxes, breeding boxes, nesting material, or humidity boxes?

  • EXERCISE/ACTIVITY

  • Does {petName} travel?*
  • Is {petName} ever boarded?*
  • Does {petName} ever receive grooming or trimming services?*
  • Does {petName} shed or molt?*
  • Have you noticed any behavior or activity changes with {petName}?*

  • REPRODUCTIVE

  • Is {petName} spayed or neutered?*
  • Has {petName} ever bred?*
  • How many times?
  • How many successful pregnancies?
  • Have you observed any breeding behaviors from {petName}?*
  • Is {petName} an egg layer?*
  • Are these eggs consumed by humans?

  • ELIMINATIONS

  • Have you observed any change in the amount or frequency of {petName}'s eliminations or droppings?*
  • Have you observed any change in the quality or consistency of {petName}'s eliminations or droppings?*
  • Has {petName} had abnormal discharge?*
  • Have you observed any blood in {petName}'s eliminations or droppings?*

  • AUTHORIZATIONS, PREVIOUS RECORDS, AND PATIENT PHOTO

  • Do we have permission to share {petName}'s image and story on our social media, website, and other forms related to media?*
  • Date*
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  • Pet Photo:

    Please feel free to upload your favorite picture of {petName}, and we will update {petName}'s hospital chart to include their photo.

    *This photo will not be used for any other purpose than the patient's hospital chart. Uploading a photo does not give the hospital permission to use this photo on any social media accounts.

  • Should be Empty: