Small Mammal History
Client Information
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Patient Information
Pet Name
Species
Sex
Please Select
Intact Male
Intact Female
Neutered Male
Spayed Female
Unknown
Age
exact birthday or approximate age
Color/Markings
black and tan, white with pink tail, etc.
How often is your pet handled?
Daily
Occasionally
Never
Do you have other small mammals?
Yes, shared cage
No
Yes, separate cage
Other pets in shared cage
*
Please list any other pets in the household:
2 dogs, 1 cat, 3 snakes, etc.
History
Where did you get your pet?
breeder, pet store, online, etc.
How long have you had your pet?
2 years, born in your care, etc.
Does your pet have any past medical history?
illnesses, vet visits, chronic symptoms, etc.
Has your pet had any vaccines?
Yes
No
Vaccines and date given
Fecal Consistency
soft, hard, formed, liquid, paste, etc.
Do you use parasite prevention?
Yes
No
Only as needed
What product do you use?
Revolution, etc.
When was most recent dose?
-
Month
-
Day
Year
Date
Enclosure
Enclosure Type
metal cage, wooden hutch, glass tank, etc.
Enclosure Size
approximate dimensions L x W X H
Substrate
wood chips, fleece, plastic tray, etc.
Type of Food & Water containers
bowls, bottles, etc .
How often is the enclosure cleaned?
spot clean daily, deep clean weekly, etc.
What do you clean the enclosure with?
water only, enzyme cleaner, vinegar, bleach, etc.
What types of toys and furniture are in the enclosure?
wooden house, hiding place, plastic wheel, metal shelves, cooling stone, etc.
Does your pet go outside?
Yes
No
How often? Supervised?
daily supervised, weekly unsupervised, etc.
Diet
How much do you feed? Please list brand and type of food (i.e. Oxbow timothy hay).
Uploads
Upload any previous records, if applicable, and include any photos of your pet and their environment that may be helpful. We strongly recommend at least uploading a picture of their enclosure.
Document & Photo Uploads
Browse Files
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Choose a file
please attach previous records (if available) and any photos you'd like to share of your pet and/or their enclosure!
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