Small Mammal History Form

Form to be sent to owners of reptile prior to exam for history

Client Name
Client email*
Pet's Name
Species
What is your pet coming in for? Describe symptoms and duration
Where and when did you get your pet?
Is this pet vaccinated?
Is this pet housed with others in the same cage?
Do you have other animals in the home? What species?
Have you provided treatment for your pet? What did you use?
Have there been behavior changes or previous health problems?
What type of housing is your pet in?
- Select All
- Glass
- Plastic
- Wood/metal
What size is the cage and what furnishing are present?
What substrate do you use on the bottom of the cage?
Where is the cage located? What is in the room?
How often do you clean the cage?
How do you clean the cage?
Is your pet let out of the cage? Please describe
Do you use any lighting? How many hours and what type of light?
Is there direct sunlight? How many hours?
What do you feed your pet?
How often do you feed your pet? What do you feed?
How often do you change water?
Do you use supplements? Please List
Are there changes in droppings?
Have there been any recent changes in the home or environment?
Anything else you would like to tell us?

Are you new to us? Tell us more about your critter! New Client Form

We look forward to welcoming you to our practice!