Pre-visit history pocket pets

Pet Name *

First

Last

Species *

Confirm email address *

Where did you get your pet? *

How long have you had your pet? *

Last vet visit date and reason. *

Current medications and/or supplements *

Has your pet ever been vaccinated? If yes, which vaccines? *

Please describe the type of enclosure, with dimensions *

Enclosure substrate? *

Please list any furniture or features in the enclosure including the materials *

Location of enclosure *

Other animals in enclosure? Male or female? *

Any other animals in the home (but not enclosure)? *

Is your pet supervised when outside their enclosure? *

Yes, always Yes, mostly No (free roam) N/A (doesn't leave enclosure)

If your pet spends time outside enclosures, where do they go? *

What is the water source? *

Approximate water intake *

How often is the drinking water changed? *

Daily Every second day Weekly Other

Current diet (including brand and flavours,) *

Treats offered (including brand and flavours) *

Amount fed and frequency (diet) *

Amount fed and frequency (treats) *

General behaviour (playing, hiding, activities...) *

New behaviour changes, if any *

Vomiting *

Yes- Lots Yes- Rarely No

Hair loss or Excessive shedding *

Yes- Lots Yes- a bit No

Coughing or troubles breathing *

Yes- Lots Yes- Rarely No

Change in defecation (including diarrhea) *

Yes- Often Yes- Rarely No

Swelling or Discharge from eyes *

Yes No

Wounds or sores *

Yes No

Sneezing *

Yes- Lots Yes- Rarely No

Lump(s) *

Yes- New Yes- Old No

Limping or troubles getting around *

Yes- Lots Yes- Sometimes No

Pain *

Yes No

Parasites *

Yes No

Head tilt and/or balance issues *

Yes No

Other concerns (please list) *

Itching and licking- please score out of 10 (0= no itching, 10= never stops) *

Please elaborate on any identified concerns (eg when it started, frequency of issue, if it is worsening or staying the same etc) *

We would like to keep your pet as calm as possible. What can we do to help make them comfortable? (eg. favourite treats, approaching, tips for handling) *

Pre-visit history form