Rabbit/Rodent History Form

General Information

Client Name

First Last

Patient Name

First

Patient date of birth

Species

Gender

Is your pet Spayed/Neutered?

Where did you obtain your pet?

How long have you had your pet?

What other pets are kept in the house?

Is the animal kept indoors or outdoors?

Describe the cage enclosure (size, type, objects in cage, etc.)

What type of material is used to line the bottom of cage/litterpan?

How much does your pet spend outside the cage?

Is your pet supervised when it is out of the cage?

Does your pet chew on carpet and/or other objects when outside the cage?

Please list recent changes in the environment if any:

What does your pets diet consist of (please be specific in amounts/what exactly your animal eats/if there has been any recent changes) ?

How often do you change your pet's food?

What (if any) treats do you give (brand and amount)?

Do you supplement your pet with any vitamins? If so, how frequently/what brands?

Has your pet been bred before? If yes, how many times and when was the last time?

Do you plan on breeding this pet in the future?

If your pet is here for an illness, please describe the symptoms/how long your pet has been showing them:

How is your pet's activity level?

How is your pet's appetite?

Have you noticed any of the following?

Has your pet had any previous conditions, operations, or problems (including dental or gastrointestinal problems)?

Is your pet currently on any medications? If yes, please describe (medication, dosage, duration, frequency, etc.)