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(908) 359-2000

Mon–Thur 7:30am–7pm | Fri 7:30am–6pm | Sat 8am-1pm
10 Sunset Road | Belle Mead, NJ

Vet Services
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Clients
- Current Clients
- First-Time Clients

Vet Services
Meet the Team
Pharmacy
Clients
- Current Clients
- First-Time Clients

Exotic Companion Animal History

Exotic Companion Animal History

GENERAL INFORMATION

Species/breed

How long have you had your pet?

Age

Sex

Male

Female

Spay/Neutered

Yes

No

If yes, when and what age?

HOUSING/ENVIRONMENT

Size/Type of Cage

What do you use for bedding?

How often is the cage cleaned?

What cleaning agents do you use?

How often is bedding changed?

Litter trained?

Yes

No

What type of litter used?

Any toys/enrichment ? (please list)

Location of the pets housing in the home

PERCENT OF TIME YOUR PET SPENDS

Confined in cage

Out without supervision

Out under direct supervision

Does your pet have access to the outdoors?

How often?

Is your pet handled?

How often?

List other pets in household

Any changes to your pets environment in the last 6 months

Is there direct contact?

Has your pet been out of the home in the last year?

DIET

Pelleted diet (%)

Pelleted Brand

Fresh produce (%)

Fresh Brand

Treats (%)

Treats Types

Other foods (%)

Other Types

Supplements/vitamins/water additives (list types)

How is food offered and when?

Last time your pet ate

How is water provided?

How often is it changes/re-filled?

Is anything added to the water?

MEDICAL HISTORY

Has your pet ever been reproductively active?

Has this pet been examined by another veterinarian?

Any injuries, illnesses, or surgeries?

List any vaccinations

Has your pet ever had a vaccine reaction?

ANY OF THE FOLLOWING SYMPTOMS?

Cough

Yes

No

Sneeze

Yes

No

Runny nose

Yes

No

Runny eyes

Yes

No

Behavior issues

Yes

No

Vomiting/regurgitation

Yes

No

Abnormal droppings

Yes

No

Changes in appetite/thirst

Yes

No

Is your pet exposed to environmental irritants or toxins?

Describe any concerning problems

When did you first notice the problem?

Has it gotten any worse?

Have you (or your veterinarian) administered any medications or treatments?

PLEASE LIST

Oral

Via food/water

Injection

Topical

Have the treatments helped?

If you are human, leave this field blank.

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(908) 359-2000
Mon-Thurs: 7:30am - 7pm
Fri: 7:30am - 6pm
Sat: 8:00am - 1pm
10 Sunset Road
Belle Mead, NJ, 08502

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