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?