Exotic Companion Mammal History & Husbandry Questionnaire
All fields marked with * are required and must be filled.
Please complete the following questionnaire to help us better understand your pet’s health, environment, diet, and husbandry.
Name
*
First Name
Last Name
Pet's Name
Species
Breed/Variety:
Approximate Age
Sex
Male
Female
Unknown
Other
If known, is your pet spayed/neutered?
Yes
No
Unknown
Housing & Environment
If you would like, please send us a picture of your housing setup along with the patient’s first and last name to redwoodvet@yahoo.com.
What type of enclosure does your pet primarily live in?
Cage
Hutch
Pen/playpen
Aquarium/terrarium
Enclosed room
Free-roaming
Combination of enclosure and free-roaming
Other
Approximate enclosure dimensions
Length | Width | Height
Where is the enclosure located in your home?
How much time does your pet typically spend outside of the enclosure each day?
What is used to line the enclosure?
Paper bedding
Fleece
Wood-based bedding
Straw
Hay
Pellets
Newspaper/Paper
No Bedding
Other
If other, please describe:
How often is the enclosure/bedding cleaned or replaced?
Please describe any additional furniture, toys, or enrichment provided:
Does your pet live with or have regular contact with other animals?
Yes
No
If yes, please list the species and number of animals:
Does your pet share an enclosure with another animal?
Yes
No
If yes, please describe:
Does your pet have access to the outdoors?
Yes
No
If yes, how often?
Diet & Nutrition
Does your pet receive a commercial pellet or formulated diet?
Yes
No
Brand and type:
Approximate amount offered per day:
Does your pet have access to hay or other forage?
Yes
No
Not applicable
If yes, please indicate what type of hay is provided:
Does your pet receive fresh vegetables, greens, fruits, or other fresh foods?
Yes
No
What foods are regularly offered?
What treats or additional foods does your pet receive?
Is food available free-choice throughout the day?
Yes
No
Is your pet currently receiving any vitamins, minerals, or other supplements?
Yes
No
If yes, please list the supplement(s), brand, amount, and frequency:
Is your pet currently receiving any medications?
Yes
No
If yes, please list the medication(s), dose, and frequency:
Medical History
Has your pet had any significant previous illnesses or medical conditions?
Yes
No
Unknown
If yes, please describe:
Pet Owner Signature
*
Today's Date
*
Submit
What type(s) of heating source are used?
Should be Empty: