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Vet Clinic Ooltewah & Chattanooga
423-238-5870
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423-238-5870
423-238-5870
Home
About Us
Our Doctors
Testimonials
FAQ
Join Our Team
Services
All Services
Diagnostic Laboratory
Pet Surgery
Endoscopy & Ultrasound
Pet Medical Boarding Services
Angel Fund
Online Pharmacy
Forms
Gallery
Blog
Contact
Rabbit and Rodent History Form
You are here:
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Rabbit and Rodent History Form
OWNER PERSONAL INFORMATION
First Name
*
:
Last Name:
Email
*
:
Patient Information
Name:
Species:
Gender:
M
F
Unknown
Spayed/Neutered:
Yes
No
Unknown
Date of birth:
Date acquired:
Source (pet store, breeder, previous owner):
Number of previous owners (other than breeder, store):
What states and/or countries has your pet lived in?:
Environment
Is the animal kept indoors or outdoors?:
Indoors
Outdoors
Describe the cage enclosure (size, type, objects in cage - dust bath, toys, etc.):
What type of material is used to line the bottom of the cage/litter pan?:
Is the animal kept in the cage with other animals?:
Yes
No
How many cage-mates are there? What sex are the cage-mates? Are the cage-mates spayed or neutered?:
Please list all other pets in the household:
Have there been any new pets (within the last 6 months) placed in this animal’s cage?:
How much time does your pet spend outside of the cage?:
Is your pet supervised when it is out of the cage?:
At all times
Sometimes
No
Does your pet chew on carpet or other objects/materials when outside of the cage?:
Please list recent changes in the environment, if any:
Diet
What amount of your pet’s diet consists of the following (please describe what the animal actually eats, not what is offered):
Amount of hay (timothy, alfalfa, etc.):
Amount of pellets (timothy, alfalfa, etc.):
Amount of seeds (type/brand):
Amount of vegetables (types):
Amount of fruits (types):
Other: Amount/type:
How often do you change your pet’s food?:
What (if any) treats do you give your pet (brand and amount)?:
Do you supplement your pet with any vitamins? Is the food or water supplemented with vitamins?:
Yes
No
Please list brand and frequency:
Please describe any recent change to your pet’s diet:
Reproductive
Has your pet been bred before? If yes, how many times?:
Yes
No
How many times:
When was it last bred?:
What was the size of all previous litters? Were the litters healthy?:
Do you plan on breeding this pet in the future?:
Yes
No
Maybe
Is your pet here for a:
Check-up
Illness
Please describe the signs/symptoms and how long your pet has been showing these signs/symptoms:
Is your pet’s activity level:
Normal
Decreased
Increased
Is your pet’s appetite:
Normal
Decreased
Increased
Have you noticed any of the following:
Weight loss
Weight gain
Discharge from the eyes or nose
Increased breathing rate or effort
A change in the droppings
An increased or decreased thirst
Weakness
Cecotropes (Rabbits)
How often?:
Previous Conditions
Has your pet had any previous conditions, operations, or problems (including dental or gastrointestinal problems)?:
Miscellaneous
Is your pet currently on any medications?:
Yes
No
Has your pet been on any medications recently?:
Yes
No
Please list them:
Is there anything else you would like done today?:
Yes
No
Please list them:
Are there any additional questions you have for the doctor?:
Upload Photo(s)
Please submit habitat photos below:
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