Small Mammal History Form

Name*

First Last

Pet's Name*

First Last

Species*

Gender*

Is your pet:*

Age (if known)

Where did you get your pet:*

If other, please specify:

What type of enclosure:*

If other, please specify:

Does your pet live indoors or outdoors?*

Does your pet have a cage mate?*

What type of substrate do you use?*

If other, please specify:

How is water offered?*

If other, please specify:

What is your pet's diet? (pellets, hay, etc.)*

How much food is given and how frequently?*

Has the small mammal been seen by another veterinarian?*

If yes, please include name and phone number of veterinarian:

Please upload photo of enclosure (optional):