Small Mammal Pre-Examination Form - CVETS - Columbia Veterinary Emergency Trauma and Specialty

Species*

Pet's Name*

Where did you acquire your pet?*

How long have you owned your pet?*

What do you feed your pet? (Please list all food items)*

If multiple food items, what percentage of each? And what does your pet actually eat (i.e. hay, pellets, vegetables, etc.)?*

Do you use a vitamin or other supplement?*

If you use a vitamin supplement, what type do you use?*

Does your pet drink from a bowl or water bottle?*

What type of enclosure do you have for your pet?*

How big is the enclosure?*

What substrate do you have on the bottom of the enclosure? How often do you clean it?*

What cage decorations are in the enclosure?*

Is your pet litter box trained?*

If your pet is litter box trained, what type of litter do you use?

Are there any toys or other items that are available to your pet?*

If your pet has access to toys or any other items, please list what they are.

Does your pet get free time out of their cage?*

If your pet gets free time out of their cage are they supervised?

If your pet gets free time out of their cage, describe their free range area.

Has your pet been vaccinated for Rabies?*

If so, what year?

Has your pet been vaccinated for Distemper?*

If so, what year?

Is your pet on flea or heartworm prevention?*

If so, what type?

Has your pet had a blood panel performed within the last year?*

Please list any previous medical problems or past concerns.*