rat/mouse history questions – new patient

Please complete this form if you are bringing your rat or mouse to us for the first time. If your rodent has visited us in the past, please complete the Existing Patient Form instead.

Owner First Name *

Owner Surname *

Owner Phone Number *

Rodent's Name *

Breed *

Age *

Gender *

Are they desexed? *

Describe their housing arrangements (free range, hutch, etc.) *

Are there any other rodents/animals at home? If so, please list. *

Were any new pets introduced to the household recently? If so, were were they acquired from, and when? *

What is their diet? List all foods offered, including the amount. *

What treats do they receive? Include the amount and frequency of each. *

Is parasite prevention up to date? What was applied/administered, and when? *

Describe the problem, including when it started? *

Has there been a recent change in environment? *

Have you noticed any diarrhoea? If so, describe the frequency, and when it was first noticed. *

Have you noticed any breathing changes or sneezing? If so, describe the frequency, and when it was first noticed. *

Has there been a recent change in behaviour? If so, please describe. *

Has there been a recent change in thirst or appetite? If so, please describe. *

Please list any known health issues, allergies, medical problems, or long-term medications. *

Do you have any questions for the vet which haven't been mentioned in the above history questions?

Phone

THE WILD VET

Rat/Mouse History Questions – New Patient

rat/mouse history questions – new patient

THE WILD VET