Hamster/Rodent Lifestyle Questionnaire

Has your pet had any previous conditions, operations or problems (including dental or gastrointestinal problems?)

Is your pet currently on any medications? If yes, please describe (time of last dose, concentration, drug name)

Has your pet recently been on any medications or supplements? If yes, please provide the name and frequency of doses:

Date of last examination *

DIET

This section is VERY important. Please be as accurate as possible.

What is the current diet? Please include brands, amount offered, and amount consumed:

Pellets

Hay

Fresh Vegetables

Fresh Fruit

Treats (describe in detail)

Seeds

ENVIRONMENT

Where is the pet kept? *

Describe the enclosure (type, size, objects in cage, etc.)

What material is used to line the bottom of the cage/litter pan?

Is the pet kept in a cage with other animals? *

Yes
No

Please list all other pets in your household

How much time does your pet spend outside of the cage?

How much time does your pet spend outdoors

Is your pet supervised when it is out of the cage?

Does your pet chew on carpet or other objects/materials/carpet when outside of the cage? *

List any recent changes in your pet's environment:

REPRODUCTIVE

Has this pet been bred before? If yes, how many times?

When was this pet last bred?

What was the size of all previous litters? Were they healthy?

Do you plan on breeding this pet in the future?

Yes
No

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *

Hamster/Rodent Lifestyle Questionnaire

CLIENT INFORMATION

PATIENT INFORMATION

REASON FOR VISIT

MEDICAL HISTORY

DIET

ENVIRONMENT

REPRODUCTIVE

Hamster/Rodent Lifestyle Questionnaire

CLIENT INFORMATION

PATIENT INFORMATION

REASON FOR VISIT

MEDICAL HISTORY

DIET

ENVIRONMENT

REPRODUCTIVE

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