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Pet's Name: *
Pet Type: Small mammal Bird Reptile
What prompted you to bring your pet in today? Wellness Nail trim Injury Other
How was your pet acquired? Store Rescue Previous Owner Breeder Other
In years, how long ago was your pet acquired? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
In years, how old is your pet? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
Is this age exact or an estimate? Exact Approximation
Please check whichever applies: This is my only pet My pet shares an enclosure with other pet(s) of the same type My pet interacts with other pets of the same type in my household but does not share an enclosure There are other pets of this type in my household, but they are kept apart/in separate areas
Please describe your pet's habitat as best as possible:
Enclosure size and type:
Location within the home:
Enrichment/toys offered:
Types of bedding/litter/substrate:
Frequency of enclosure cleanings:
Does your pet have any exposure to unfiltered UV light (not through a window)? No UV exposure Time spent outdoors UV light over enclosure
If you have a UVB bulb, how often do you change it?
Please check whichever applies in regards to how your pet spends time in a cage/enclosure: My pet is almost always in its enclosure My pet spends supervised time out of enclosure My pet spends unsupervised time out of enclosure
Please describe your pet's diet and amounts, including any people food, treats, etc.: (Please use brand names if possible.)
What supplements, vitamins or medications is your pet currently taking?
Do the droppings appear normal? If no, please describe what has changed: Normal Not normal If not normal please describe:
Do you bathe your pet or soak your reptile? Yes No
If so: How often? Daily Weekly Monthly Bimonthly Quarterly Semi-annually Annually As needed Never Other
What do you use?
Is there anything in your pet's previous medical history that we should be aware of? (ex: illnesses, injuries, hospitalizations, allergies, egg laying, etc.)
Describe any heating/light elements you use, and how you use them during the day and at night.
How do you measure temperature and humidity within your reptile's enclosure?
If known, what are the parameters inside the enclosure? (for example, is the temperature on the cool side or warm side, humidity, coolest night temperature, etc.)
Is your bird flighted or non-flighted currently? Flighted Non-flighted
How has your bird's gender been determined (if at all)? Sexual dimorphism DNA sexing Egg laying Has not been reliably determined
If sexed, Male or Female? Male Female Unknown
If you have noticed any behavioral changes to your bird recently or have previously been seen by a Veterinarian for behavioral issues, please describe:
How long have the behaviors listed above been occurring, and how frequently?
Have any of the behaviors noticed changed in duration, intensity, or frequency over time?
Is there anything specific that you've noticed relating to when the behaviors occur? (ex: when you leave the house, only at night, seasonal, only around a certain person, etc.)
When your bird is engaging in these behaviors, how have you been responding?
Have you tried any treatments or made any changes in an attempt to correct any of the behaviors listed? If yes, what did you try? How effective did you feel the change/treatment was?
How long has it been since your bird or reptile laid an egg for the first time?
How frequently does your bird or reptile lay eggs, and when was the last time she laid one?
Has your bird or reptile ever had a difficult time laying eggs? If so, please explain the issue: (ex: straining, blood present, prolonged recovery, etc.)
To the best of your knowledge, have the eggs always looked like they were of normal size, shape, and thickness? If no, please explain what you noticed:
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