• EXOTIC COMPANION MAMMAL HISTORY FORM

    Please help us get to know your pet
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Pet Details

  • Sex*
  • Does your pet have a microchip?*
  • Is your animal vaccinated?*
  • Do you have any other pets in the household?*
  • Do people who have contact with the animal have symptoms similar to the animal?*

  • Reason for visit today

  • Has your pet received any treatment in the last 30 days?*
  • Has your pet been seen by another veterinarian?*
  • Have you noticed any change in your pet’s behavior?*
  • Have any animals or people in the house become sick in the last 30 days?*

  • Diet

  • Indicate which foods are eaten and in what amounts
  • Do you use any nutritional supplements (calcium, multivitamin, etc)?*
  • Any recently added food or dietary changes?*
  • What water supply do you provide?*
  • How is water provided?*
  • Do you use any water supplements?*
  • Have you noticed any changes in eating or drinking behavior?*

  • Cage Environment

  • Where is the cage located?*
  • Is your pet supervised when out of the cage?*
  • Are bathing/soaking facilities provided?
  • Does anyone in the household smoke?
  • Do you use any aerosolized products?
  • Have there been any changes in the pet’s environment in the last 3 months?
  • Please list any other avian or exotic pets
  • Should be Empty: