RABBIT/RODENT HISTORY FORM

Full name of Owner/Caregiver (must be over 18 years old):

Phone

Name of pet

Species

Age

Sex

Male Female

Spayed/Neutered

Yes No Unknown

Length of time owned

Place of Purchase/Adoption

Background Information

If there are other pets at home (other rabbits/rodents, dogs, cats, etc.), please list species, date acquired, and place of purchase/adoption

Please give details on your pet’s vaccination history (i.e., rabbit hemorrhagic disease) and include the date of the last vaccination.

Husbandry

Please describe your pet’s cage/enclosure including the size of the cage, the material it is made of, location in the home, types of toys present, if it shares the cage with another pet, how often it is cleaned, and what is used for bedding (i.e., blankets, wood shavings, etc.).

Please describe how often the cage is cleaned and what cleaning products are used.

If a litter box is present, please describe how often it is cleaned and the type of litter used.

Please describe your pet’s time outside of the cage including how often and for how long it comes out of the cage, whether or not they are supervised, and where the pet spends its time when out of the cage. Please include whether or not they go outside.

Nutrition

Please provide details on your pet’s diet (i.e., pellets, seed mix, hay, vegetables, fruit, treats). Include brand names, amounts given, what type of hay, and how often your pet is fed.

Please provide details on any supplements you give your pet (i.e., vitamins, salt licks, mineral block, etc.)

Please provide details on the water offered (i.e., tap, filtered, bottled), if it is in a bowl or bottle, how often the water is changed, and how often the bowl/bottle is cleaned.

Medical History

Please describe your pet’s previous medical history/problems

If your pet is currently ill, please describe the medical concern in detail including the duration of the problem and if the clinical signs are getting worse, better, or not changing.

If your pet is currently on medications, please give the name of the medication, the reason it has been prescribed medication, and the pet’s response to the medication (i.e., is there improvement?)