Niles Animal Hospital / Small Mammal History Form

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Small Mammal History Form

Personal

Owner's Name

Name of Pet(s)

Species

Age

Sex (M/F/Unknown)

How long have you been keeping this species of pet?

How long have you had this pet?

Medical

Purpose of visit

Previous Veterinarian (if any)

If illness, describe signs, duration,and severity:

Coughing (Y/N)

Sneezing (Y/N)

Vomiting (Y/N)

Diarrhea (Y/N)

Lameness (Y/N)

Scratching (Y/N)

List existing or previous medical conditions:

List any medications given

Diet

What food is offered and what is eaten? (Include brand names, frequency, and method of feeding)

Supplements or vitamins

Water

Dish or bottle?

How often is container refilled?

How often is container cleaned?

Housing

Size and type of cage

Type of bedding

Frequency of cleaning

Kept alone or with how many others?

Exercise

Please describe method and frequency of exercise

Handling

How often?

By whom?

Other

Any other pertinent information?

These tips can help you avoid potential shipping delays of your pet's medication and nutrition.

Check levels of medications or prescription diets regularly and work with your vet to make sure you're not close to running out.
To allow for potential shipping delays, consider placing your orders a little earlier than you typically would.
If you have any AutoShip orders, we recommend shifting your order schedule by 4-5 days.

And don't forget — you can always track your order online when you log in to your account.

Use code SUMMERTIME — valid for a one-time purchase through our online store. Compounded medications not included. Other restrictions apply. Valid 6/23/23 - 6/25/23

*Up to 40% off deal includes the use of the 17% off coupon code combined with manufacturer promotions. Manufacturer promotions, including instant rebates and AutoShip discounts, are automatically applied at checkout. Manufacturer promotions are valid only through our online store. Visit specific product detail pages for manufacturer promotion details. Maximum discount of $20. Must be logged in to your account to redeem offers. Other restrictions apply. Valid until 6/25/23, while supplies last.

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Small Mammal History Form

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