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Home
Our Hospital
Our Doctors
Hospital Tour
Careers
Emergency Information
Covid-19 Information
Anesthesia and Your Pet
Ticks! Now What?
Patient History Form
Canine and Feline History Form
Exotic Mammal History Form
Owner Information Form
Services
Wellness Exams
Spay & Neuter
Vaccinations
Microchipping
Dental Care
Large Animal Services
View All Services
Equine Services
Payment Options
Shop Online
Contact Us
517-223-8812
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Exotic Mammal History Form
Exotic Mammal History Form
Client Information
Owner Name
(Required)
Owner Phone
(Required)
Patient Information
Pet’s Name
(Required)
Species
(Required)
Breed
(Required)
Age
(Required)
Color
(Required)
Gender
(Required)
Male
Female
Unknown
Spayed or neutered status
(Required)
Neutered
Spayed
Intact
This mammal is a
(Required)
Pet
Breeder
Is your pet
(Required)
Select an Option
Wild
Caught
Domestically Bred
Imported
Where did you get your pet
(Required)
Select an Option
Breeder
Pet Store
Friend or Family
Rescue
Found or Caught
Was your pet quarantined
(Required)
Yes
No
How long and where was your pet quarantined
(Required)
What type of enclosure do you use
(Required)
Aquarium
Mesh
Wire Cage
Wood Enclosure
Free Range
Indoors
Outdoors
Specific Room
Multi-Level Enclosure
Other
Please list any other types of enclosures you use
(Required)
How big is the enclosure
(Required)
How often do you clean the enclosure
(Required)
What other animals live in the enclosure
(Required)
What other animals live in the house
(Required)
What type of cage furnishings do you have
(Required)
Natural Branches
Fake Branches
Foliage
Real Plants
Hammock
Litter Box
Dig Box
Water Bowl
Hide Box
Wheel
Toys
Other
Please list any other types of cage furnishings you have
(Required)
What is on the bottom of the enclosure
(Required)
Newspaper
Corn Cob
Towel
Tile
Wire or Mesh
Paper Towel
Wood Shavings or Chips
Rubber Mat
Carpet/Bare
Dirt
Moss
Other
Please list any other types of materials on the bottom of the enclosure
(Required)
What type of wood shavings/chips do you use
(Required)
**It is helpful if pictures of the enclosure are brought to the appointment**
Do you have an air conditioner in the room
(Required)
Yes
No
How is water offered
(Required)
Dish
Tray
Bottle
How often is water changed
(Required)
Does your pet get natural sunlight
(Required)
Yes
No
How does your pet get natural sunlight
(Required)
Outdoors
Window
How often is your pet exposed to natural sunlight
(Required)
Is your pet allowed outdoors
(Required)
Yes
No
Is your pet allowed outside unsupervised
(Required)
Yes
No
How often do you feed
(Required)
What does your pet eat
(Required)
Timothy Pellets
Alfafa Pellets
Pellets with Seeds
Dried Fruits Kibble
Timothy Hay
Alfalfa Hay
Oat or Botanical Grass
Lab Blocks
Fresh Veggies
Fresh Greens
Fresh Fruit
Meats
Egg
Insects Baby Food
Other
Please list any other food items your pet eats
(Required)
What brand of pellets or kibble do you use
(Required)
How often does your pet defecate
(Required)
How often do you bathe your pet
(Required)
Do you use shampoo
(Required)
What vaccines has your pet received
(Required)
How does your pet exercise
(Required)
Free Roam
Play Pen
Wheel
Interactive Toys
Other
Please list any other ways your pet exercises
(Required)
How often does your pet exercise
(Required)
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