Exotic Mammal Medical Intake Form

Owner's Name:

Patient's Name:

Reason for Visit:

Additional Concerns:

Date that Sign/Symptoms Started:

Current Diet Including Any Supplements:

Current medications including when last given:

Describe Cage Material & Size:

What is the Substrate (what you line the bottom of the cage with) of the Cage?

Where is Cage Located?

How Many Other Animals in the Home?

Date of Last Tooth Exam/Dremel if Known:

For Guinea Pigs (Type & Amount of Vitamin C Given Daily):

Eating/Drinking?

Urinating/Defecating?

Vomiting?

Coughing/Sneezing?

EXOTIC MAMMAL MEDICAL INTAKE FORM