Small Mammal Check-In Form

Owner's Information

Owner's Name (required)

Owner's Phone Number (required)

Owner's Email (recommended)

Pet's Information
Pet's Name (required)

Pet's Breed (required)

Pet's Sex (required)

Pet's Age (required)

Companion Animal? (required)
YesNo
Breeder? (required)
YesNo
Background Information
Length of Time Owned: (required)

Where was the pet acquired? (required)
BreederPet StoreOther
How often is the mammal handled? (required)
DailyOccasionallyNever
Fecal Characteristics (required)

Husbandry
Is the animal housed indoors or outdoors? (required)
IndoorsOutdoors
Allowed to roam free in the house? (required)
YesNo
Where is the cage located?(required)

Size of cage (required)

Type of cage (required)

Galvanized: (required)
YesNo
Cage Substrate: (required)

How often is the cage cleaned? (required)

What type of disinfectant is used to clean the cage? (required)

Types of Toys: (required)

What are the toys made of? (required)

Nutrition Information
Type of Food (required)

Hay? (required)
YesNo
If yes, please specify the brand, frequency, and amount.

Pellets? (required)
YesNo
If yes, please specify the brand, frequency, and amount.

Supplement/Treats Offered and Frequency (required)

Amount fed/frequency (required)

Last feeding date (required)

Water source (required)

How often is the water changed? (required)

Any other mammals in the home? (required)
YesNo
If yes, please specify.

Are animals housed together? (required)
YesNo
If yes, please specify.

If not housed together, where are other animals located?

Any new additions to the mammal population? (required)
YesNo
If yes, please specify.

Past medical history/problems

Current presenting problems

Δ