Brunswick, ME

Small Mammal/Rodent History Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at for a faster response.

Owner's Name *

Email *

Pet's Name *

Species/Variety *

How long have you owned, and where did you adopt or purchase? *

Other small mammals in the home? *

Enclosure type and size *

Furnishings in enclosure

Ventilation in enclosure (mesh, grills, etc) *

Cage cleaning pattern and cleaning agents used *

Bedding type *

Please describe any inside or outside special exercise station or run *

How often is this used? *

Diet - How often fed and specifics on diet:

Pellets (type and amount)

Hay (type and amount)

Fruits and veggies (type and amount)

Treats (type and amount)

Any other/meat/dairy?

How is water offered and when changed? *

Any water supplement given? *

Any supplements or vitamins offered? *

List any medication given and reason

Are there any smokers in the household? *

Is there a fireplace in the household? *

Toys, treats, or chews offered, and how often? *

What is day and night cycle? *

Any special lighting or temperature set ups? *

Any other health issues with other pets? *

Small Mammal/Rodent History Form

Diet - How often fed and specifics on diet:

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