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Owner's Name
Today's Date
Phone
Email
Pet's Name
What species is your pet? (Please be specific Hooded Rat, Teddy Bear Hamster, English Lop Rabbit, etc.)
How old is your pet? Provide DoB if possible.
Sex
Male
Female
Unknown
Is your pet spayed / neutered?
Yes
No
How long have you had this pet?
Where was this pet acquired?
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FEEDING
What does your pet eat? (Please be specific: primary diet, vitamin supplements, and treats.)
How often do you feed and/or change food?
Once
a
day
Twice
a
day
Free-Feed
/
Continuous
Other
Please specify:
How often is water changed?
Does your pet drink from a water or a bowl?
Bottle
Bowl
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ENVIRONMENT / HOUSING
What kind of enclosure is your pet kept in?
Type of substrate: (ie: bedding)
How often is the substrate changed?
Average Temperature (if known)
Do you allow your pet to roam around the house or yard?
Are there any other animals in the same cage?
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MEDICAL ISSUES
Please list any past or current health problems:
Please list any specific concerns or questions you have about your pet's health or husbandry:
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