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Home » Forms » Pocket Pet History Form

Pocket Pet History Form

"*" indicates required fields

Date*

MM slash DD slash YYYY

Pet's Name*

Breed*

Sex*

Male

Female

Age*

Is this a companion animal or are you a breeder?*

Companion Animal

Breeder

Background Information

Length of time owned*

Where was the pet acquired?*

Pet Store

Other

If Other, please explain*

How often is the animal handled?*

Daily

Occasionally

Never

Character of feces*

Husbandry

Housed indoors or outdoors?*

Indoors

Outdoors

Is animal allowed to roam free in the house?*

Yes

No

Where is the cage located?*

Type of caging*

Galvanized?*

Yes

No

Size of cage*

Cage substrate*

How often is the cage cleaned?*

What type of disinfectant is used when cleaning cage?*

Type of cage furniture*

Are there chew toys in available in cage?*

What are they made of?*

Nutrition

Are pellets being offered?*

Yes

No

If yes, what brand?*

Amount fed/frequency*

Supplements offered and frequency

i.e. seeds, vegetables, etc

Water source?*

How often is water changed?*

Any other pets?*

Yes

No

If yes, please specify*

Any other pocket pets?*

Yes

No

If yes, please specify*

Are animals housed together or apart?*

If not housed together, where are the other animals located?*

Any new additions to the pocket pet population?*

Yes

No

If yes, please specify*

Past Medical History/Problems

Current presenting problem*

Duration of complaint*

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Phone

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