Does your pet ever go outside? (required) No Yes, supervised playtime Yes, unsupervised playtime (includes time in cage/fenced area, if no human present) Yes, lives outside in good weather Yes, lives outside all yearDoes your pet live primarily in a cage, hutch, or other enclosure? (required) Yes NoIf Yes, what are the dimensions of the cage? If No, what rooms are dedicated to play vs. free range? Does your pet share a cage with any other pets? (required) Yes NoDoes your pet interact or live with other pets outside of a cage (including supervised playtime)? (required) Yes NoWhat bedding do you use in your pet’s cage? (required) CareFresh, Kaytee SoftSorbent, CelSorb, Yesterday’s News, or other paper/pulp bedding Aspen shavings or pellets Pine or Cedar shavings or pelletsAre there any houseplants in your pet’s environment? (required) Yes NoIf Yes, what kind: How often is the cage/bedding/litter changed? (required) Are the room(s) where your pet lives / where cage is located air conditioned? (required) Yes NoAre the room(s) where your pet lives / where cage is located heated? (required) Yes NoDoes your pet use a litterbox? (required) Yes NoIf Yes, what litter do you use? What sort of pelleted food does your pet eat? (Please include brand + type, if known): (required) Pellet mix contains (Please check all that apply): (required) Plain pellets Oats or other grains Seeds or nuts dehydrated vegetable pieces Colored/flavored pieces, dehydrated fruit, or corn OtherWhat sort of hay does your pet eat? (Please check all that apply): (required) Timothy Orchard Grass (or other grass) Alfalfa OtherHow often is hay fed? (required) How much hay is fed? What fresh greens, vegetables, or fruits does your pet eat? (required) How often are fresh foods fed and how much? (required) Is FRESH water changed/given every day? (required) Yes NoSipper bottle or bowl? (required) Do you give a vitamin supplement? (required) Yes NoAre vitamins put in the pet’s water? (required) Yes NoFor guinea pigs – does supplement contain Vitamin C? Yes NoPlease tell us about anything else your pet eats: Patients Name: (required) Today's Date:. (required)
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Appointment Date & Time (required)
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