Small Mammal Health History Form

Name*

Species*

Age*

Gender*

Male

Female

Unknown

Where did you acquire your pet?*

Breeder

Pet Store

Wild Caught

Rescue

Other

How long have you owned this pet?*

Housed alone or with others?*

Alone

With others

Past illnesses or significant medical history*

How often is your pet handled?*

What types of play and interaction?*

Is your pet vaccinated?*

Yes

No

Is your pet on parasite prevention?*

Yes

No

Small Mammal Health History

Pet Information

Name*

Species*

Age*

Gender*

Where did you acquire your pet?*

How long have you owned this pet?*

Housed alone or with others?*

Past illnesses or significant medical history*

How often is your pet handled?*

What types of play and interaction?*

Is your pet vaccinated?*

Is your pet on parasite prevention?*

Any changes to appetite, thirst, urination, defecation?*

Changes to behavior?*

Your Pet's Husbandry

Sunshine: does your pet have outside time? How often and for how long?*

Water source: how often is it changed? Bottle vs bowl?*

Baths: does your pet get bathes? How frequently, with what?*

Enclosure: size of area, size of bars, made of glass/plastic/wood/metal, material at bottom of cage, furniture inside?*

Where is enclosure located in home? Away from other pets? Near windows?*

Cleaning enclosure: how frequent, and with what products?*