• Exotic Mammal History Form

  • Patient Information

  • Sex*
  • From where did you obtain this animal?*
  • Is your animal vaccinated?*
  • Do you have any other pets in the household?*
  • Has the animal had any contact with any animals outside your household within the past 30 days?*

  • Husbandry Questionnaire

  • Where is the cage/enclosure located?*
  • Is your animal supervised when out of the cage?*
  • Is there ventilation (grills or mesh)?*
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  • How often is the cage/enclosure cleaned?*
  • Is your animal litter trained?*
  • Has there been any changes in the environment in the last 3 months?*

  • Food/Nutrition Questionnaire

  • How is water offered?*
  • Have you noticed any changes or have any concerns about your animal's feeding or drinking behavior?*
  • Have you noticed any changes or have any concerns about your animal's droppings?*

  • Preventative Care and Medical History

  • Is your animal currently receiving any treatments or preventatives?*
  • If applicable, are the other animal(s) in the household also on preventative medications?*
  • Is your animal currently receiving any medications on a regular basis?*

  • Appointment Information/Reason

  • Have you noticed any signs, symptoms, or changes in behavior?*
  • Does this animal have any previous medical or health problems?*
  • Have any other animals or persons in the household had any illness within the past 30 days?*

  • Miscellaneous

  • Should be Empty: