Name: Macungie Animal Hospital
Address: 161 East Main St, Macungie, PA, 18062, US
Telephone: (610) 421-8381
Price range: $$

Small Mammal History Form

Owner's Name*
First Last
Your Pet’s Information
Name*
Species Or Common Name
Date of Birth or Age (if known)*
Sex*
Neuter/Spayed?*
- Yes
- No
How long have you had your pet?
From where did you obtain your pet?
Do you have other pets in the household?*
- Yes
- No
Cage Details
Where is the cage located?*
- Inside
- Outside
What are the dimensions of the cage and what is it made out of?*
What is in the cage set up (décor, toys, ventilation, etc)? Substrate?*
Are there are any smokers in the house?*
- Yes
- No
Do you use aerosolized substances?*
- Yes
- No
What is your pet’s day and night cycle (hours of sleep)?
What percentage of the time does your pet spend in the cage?
Is your pet supervised when out of the cage?*
- Yes
- No
Have there been any changes in the environment in the last 3 months?*
- Yes
- No
Diet Details
How often do you feed your pet?
Please indicate which foods are eaten and the approximate volume:*
Pellets, Seeds, Vegetables, Fruits, Meat Products, Treats/Others
Do you use any nutritional supplements in food or water?*
- Yes
- No
Water Details
What water supply do you provide?
- City Tap Water
- Bottled Water
- Well Water
How is water provided?*
- Bowl
- Dripper System
How often is the water changed?*
Reason for Visit today
What is the primary reason why you brought your pet in to see veterinarian today?
Have you noticed any changes in feeding or drinking behavior?*
- Yes
- No
Have you noticed any changes in droppings?*
- Yes
- No
Have you noticed any changes in your pet’s behavior?*
- Yes
- No
Has your pet had any previous health problems?*
- Yes
- No
Have any other animals or people in your household had any illness within the last 30 days?*
- Yes
- No
What are your pet’s current medications? Has your pet received any medications or treatments in the last 3 months (what was used, dosage, how often and duration):
Please attach a photo of your pet’s enclosure or cage.
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Contact

161 East Main St.,
Macungie, PA 18062

(610) 421-8381
portal@macungieanimalhospital.com

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Hours

Monday & Thursday:
8:00 AM – 7:00 PM
Tuesday, Wednesday, Friday:
8:00 AM – 6:00 PM
Saturday:
8:00 AM – 2:00 PM

Small Mammal History Form

Your Pet’s Information

Cage Details

Diet Details

Water Details