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Home Forms Mammal History Form

Mammal History Form

"*" indicates required fields

Pet's Name*

Owner's First Name*

Owner's Last Name*

Species*

Breed*

Age*

Gender*

Male

Female

Neutered Male

Spayed Female

Unknown

This mammal is a*

Pet

Breeder

Is your pet*

Wild Caught

Domestically Bred

Imported

Where did you get your pet?*

Breeder

Pet Store

Friend/Family

Rescue

Found/Caught

Was your pet quarantined?*

Yes

No

If yes, how long and where?*

What type of enclosure*

Aquarium

Mesh/Wire Cage

Wood Enclosure

Free Range

Indoors

Outdoors

Specific Room

Multi-level Enclosure

Other

If Other, please explain*

How big is the enclosure*

How often do you clean?*

What other mammals live in the house?*

What other mammals live in the enclosure?*

What type of cage furnishings do you have*

Natural Branches

Fake Branches

Foliage

Real Plants

Hammock

Litter Box

Dig Box

Water Bowl

Hide Box

Wheel

Toys

Other

If Other, please explain*

What is on the bottom of the enclosure*

Newspaper

Corn Cob

Towel

Tile

Wire/Mesh

Paper Towel

Wood Shaving/Chip

Rubber Mat

Carpet Bare

Dirt

Moss

Other

If Other, please explain*

Do you have supplement heat?*

Yes

No

Do you have an air conditioner in the room?*

Yes

No

How is water offered?*

Dish

Tray

Bottle

How often is the water changed?*

Does your pet get natural sunlight?*

Yes

No

If yes, how?*

Outdoors

Window

How long?*

Is your pet allowed outdoors?*

Yes

No

Are they allowed outside unsupervised?*

Yes

No

How often do you feed?*

How often does your pet defecate?*

What does your pet eat?*

Timothy Pellets

Alfalfa Pellets

Pellets with Seeds/Dried Fruits

Kibble

Timothy Hay

Alfalfa Hay

Oat/Botanical Grass

Lab Blocks

Fresh Veggies

Fresh Greens

Fresh Fruit

Raw/Cooked Meats

Egg

Insects

Baby Food

Other

If Other, please explain*

What brand of pellets or kibble do you use?*

How often do you bathe your pet?*

Do you use shampoo?*

What vaccines has your pet received?*

How does your pet exercise?*

Free Roam

Play Pen

Wheel

Interactive Toys

Other

If Other, please explain*

How often does your pet exercise?*

Please take a photo of your enclosure and be sure to upload it, or email it to us at [email protected].

Max. file size: 50 MB.

If your pet has been seen anywhere previously please include the name of the facility so we can obtain records ahead of time.

Signature*

Date*

MM slash DD slash YYYY

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

Get in touch

(847) 821-6189

1101 S Milwaukee Ave Ste 102,
Vernon Hills, IL 60061

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Companion Vernon Hills

1101 S Milwaukee Ave Ste 102,
Vernon Hills, IL 60061

Home
About Us
Services
Resources
New Clients
- New Client Form
PetDesk
Contact Us

Make An Appointment

Request a Prescription

Business Hours

Mon

8:00am - 6:00pm

Tues

8:00am - 6:00pm

Wed

8:00am - 6:00pm

Thu

8:00am - 6:00pm

Fri

8:00am - 5:00pm

Sat

8:00am - 2:00pm

Sun

Closed

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