What signs prompted today's visit?*
How has the problem changed?*
If your pet has been sick before, please describe.
Please describe any medications your pet is currently taking.
Please describe any laboratory tests that have been performed on your pet previously.
Has any member of your household (human or animal) had an illness in the past month?*
How did you acquire your pet?*:*
Please provide any other details on the source.
Do you have any other pets?*
If yes, please list other pets and whether they have contact with this pet.
Has your pet had any contact with any other animals (besides those listed) in the past 3 months?*
How does your pet get excercise?*
Where is this pet kept? (select all that apply)*
Is this pet housed alone?*
If no, please describe cage mates.
If pet is caged, what type / size of cage is used? Describe cage furniture and layout.
What bedding/substrate is used on the bottom of cage? How deep is the substrate? What bedding is used in the litterbox?*
Does your pet's cage flooring include a wire grate? If so, what percentage of the floor is covered by the wire grate?*
How often is the cage cleaned, using what method / products?*
If your pet's environment has changed recently, describe those changes.
Describe any bathing opportunities provided, if any.
How often and for what duration of time is your pet allowed outside of the cage?*
Is your pet supervised at all times when outside of cage?*
Is your pet litter trained?*
If pellets are offered, what brand are they?
If seed mix is given, what brand / type?
If vegetables are given, what types and are they frozen, fresh, dehydrated, or in some other form?
If fruits are given, what types and are the frozen, fresh, dehydrated, or in some other form?
If hay is offered, what type is it?
If proteins are offered, list types (insects, fish, cheese, meat) and status (live, frozen, dehydrated).
Please describe any treats that are provided.
If dietary supplements are offered, please describe the type and frequency.
If there have been any recent diet changes or new foods, please describe them.
Which water source is used?*