Small Mammal History Form Small Mammal History Form Your Pet’s Information:Name* Common name or species* Date of Birth* Sex* Neuter/Spayed?* No Yes How long have you had your pet?* From where did you obtain your pet?* Do you have other pets in the household?* Yes No Please list number and species* Cage DetailsWhere is the cage located?* Inside Outside What are the dimensions of the cage?* What is in the cage set up (décor, toys, ventilation, etc)? Substrate?* How often do you clean the cage and what do you clean it with?* Are there are any smokers in the house?* No Yes Do you use aerosolized substances?* No Yes 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 If so, please explain: Diet DetailsHow often do you feed your pet?* Please select which foods are eaten: Pellets Hay Vegetables Fruits Meat products Treats/others Pellets: Type, Brand and amount* Hay: Type, Brand and amount* Vegetables: Type, Brand and amount* Fruits: Type, Brand and amount* Meat products: Type, Brand and amount* Treats/others: Type, Brand and amount* Do you use any nutritional supplements in food or water?* Yes No What is it, how much, how often?* Water DetailsWhat water supply do you provide?* City tap water Bottled water Well water How is water provided?* Bowl Dripper system How often is water changed?* Reason for Visit todayWhat is the primary reason why you brought your pet in to see a veterinarian today?*Have you noticed any changes in feeding or drinking behavior?* Yes No Please give details* Have you noticed any changes in droppings?* Yes No Please give details* Has your pet had any previous health problems?* Yes No Please give details* Have any other pets or person in the household had any illness within the last 30 days?* Yes No Please give details* What are your pet’s current medications? Has your pet received any medications in the last 3 months (heartworm medication, dewormer, flea treatment, etc)*Please attach a photo of your pet’s enclosure or cage.Max. file size: 8 MB.