Exotic Small Mammal History FormPet NameAgeSpeciesBreedColorSex* Female Male UnknownNeutered/Spayed* Yes No UnsureIf so, when?Background InformationWhere acquired?Please select oneBreederPet storeRescueOther locationLength of time ownedWhere is your pet housed?Please select oneIndoorsOutdoorsBothDoes the animal roam freely in the house? Yes NoDoes your pet chew household items? Yes No Not sureAre there any other pets? Yes NoIf yes, please specifyIs your pet housed by itself? Yes NoIf no, please specifyAny recent additions of exotic mammals to the household?HusbandryDescribe your enclosure, including size, type of cage, position, etc. PLEASE BRING PICTURESWhat bedding/litter material is used?How often is the cage cleaned? What type of disinfectant is used?Any recent changes in housing? Yes NoIf yes, please specify.DietPlease list the items included in the diet, brand and amount/frequency fed.Are there any treats/table scraps offered? Yes NoIf yes, please specify.How often?Are there any supplements used? Yes NoIf yes, please specify.How is water offered? Frequency changed?Have there been recent changes to diet? Yes NoIf yes, please specify.If you have a ferret, please expand and fill in the information below.Is your ferret vaccinated against rabies? Yes NoIs your ferret vaccinated against distemper? Yes NoDoes your ferret receive any heartworm/intestinal parasite protection on a regular basis? Yes NoIf yes, please specify which ones and how often.Owner InformationName*Secondary Owner?* Yes NoStreet Address*Address Line 2City*State/Province/Region*Zip/Postal Code*Phone*Email*How did you hear about us?*Please select oneInternetYellow PagesSignAdPet StorePersonal ReferralPet ShowOtherHow did you hear about us?Referrer's Name:Vet HistoryPrevious Veterinarian or Veterinary ClinicAny pre-existing conditions?Have you scheduled an appointment with us? Yes (If yes, when is your appointment?) NoIf yes, when is your appointment?Date of Most Recent Vet VisitXX/XX/20XXSubmit Your Pet's Info
