Does your pet ever go outside? (required)
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Does your pet live primarily in a cage, hutch, or other enclosure? (required)
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If Yes, what are the dimensions of the cage?
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If No, what rooms are dedicated to play vs. free range?
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Does your pet share a cage with any other pets? (required)
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Does your pet interact or live with other pets outside of a cage (including supervised playtime)? (required)
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What bedding do you use in your pet’s cage? (required)
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Are there any houseplants in your pet’s environment? (required)
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If Yes, what kind:
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How often is the cage/bedding/litter changed? (required)
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Are the room(s) where your pet lives / where cage is located air conditioned? (required)
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Are the room(s) where your pet lives / where cage is located heated? (required)
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Does your pet use a litterbox? (required)
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If Yes, what litter do you use?
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What sort of pelleted food does your pet eat? (Please include brand + type, if known): (required)
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Pellet mix contains (Please check all that apply): (required)
Plain pellets
Oats or other grains
Seeds or nuts
dehydrated vegetable pieces
Colored/flavored pieces, dehydrated fruit, or corn
Other
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What sort of hay does your pet eat? (Please check all that apply): (required)
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How often is hay fed? (required)
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How much hay is fed?
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What fresh greens, vegetables, or fruits does your pet eat? (required)
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How often are fresh foods fed and how much? (required)
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Is FRESH water changed/given every day? (required)
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Sipper bottle or bowl? (required)
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Do you give a vitamin supplement? (required)
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Are vitamins put in the pet’s water? (required)
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For guinea pigs – does supplement contain Vitamin C?
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Please tell us about anything else your pet eats:
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Patients Name: (required)
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Today's Date:. (required)
:
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Appointment Date & Time (required)
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