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Services
Wellness and Life Stage Exams
Pet Dental
Urgent & Emergency Care
Surgery
Pet Boarding
Ultrasound
Digital Radiography
View All Services
Wildlife
Pet Owners
Online Forms
Apply For Care Credit
Online Store
RX Refill
Download Our App
Education
About Us
Meet Our Team
Online Store
Contact Us
Download Our App
24/7 Emergency Care
Emergency & Urgent Care
Book an Appointment
Small Mammal Questionnaire
Patient Information
Pet Name
(Required)
Species
(Required)
Approximate Age
(Required)
Sex
(Required)
Male
Female
Unknown
How long have you owned this pet?
(Required)
Where did you get this pet?
(Required)
Medical History
Has your pet been to a vet before?
(Required)
Yes
No
Has your pet been dewormed before?
Is your pet on flea prevention?
Yes
No
Please note any previously diagnosed medical concerns for your pet below
Husbandry / Care
Please bring a picture of your pet's enclosure to your appointment
Is your pet housed alone or with other animals?
Alone
With Other Animals
If your pet is housed with other animals, please describe what other animals it is housed with:
Does your per live indoors or outdoors?
Indoors
Outdoors
Has both indoor and outdoor housing
For animal's housed outdoors, does your pet stay outside all year?
Yes
No
Not applicable
Describe the pet’s housing set-up (aquarium tank, dog crate, hutch, cage). Include approximate size, construction materials & a diagram if applicable.
Does the enclosure have a wire bottom or solid bottom?
Wire bottom
Solid bottom
Other
Other
Environment
What substrate is used?
Newspaper
Carefresh
Wood shavings
Other
Does your pet use a litter box?
Yes
No
N/A
What shape is the litter box?
Triangle
Rectangle
Square
Other
How frequently is the environment cleaned?
What cleaners are used?
If applicable, how often does your pet receive a dust bath? (Skip if not applicable)
Feeding
List ALL types of food items given including quantity and frequency
Does your pet drink from a bowl or bottle?
Bowl
Bottle
Other
Please list any supplements/vitamins
Do you gut-load insects?
Yes
No
N/A
Any other comments or concerns?
CAPTCHA
Emergency & Urgent Care
Emergency & Urgent Care
Book an Appointment
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