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Home » 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)

Where did you get your pet(Required)

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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Name

This field is for validation purposes and should be left unchanged.

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517-223-8812

Fowlerville Veterinary Clinic

6440 W. Grand River,
P.O. BOX 383
Fowlerville, MI 48836

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Business Hours

Monday

8:00am - 6:00pm

Tuesday

8:00am - 6:00pm

Wednesday

8:00am - 6:00pm

Thursday

8:00am - 6:00pm

Friday

8:00am - 5:00pm

Saturday

8:00am - 12:00pm

Sunday

Closed

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