Exotic Pet History Form
Date: ___________
Place Patient Label Here
Avian
Reptile
Small Mammal
Ronda J. Borgeson, DVM
Tiffany Bohlmann, DVM
Background Information
Length of time owned: ___________
Where acquired: Breeder _________________ Pet store ____________ Other ____________
Vaccination history: _______________________________________ When was last molt? __________________________________
Character of droppings: _________________________ How often is pet handled? Daily _____ Occasionally _____ Never _____
Is the pet ever taken outside of the home?
N
Y
Where? _______________________________
Husbandry
Housed:
indoors / outdoors
Where is the cage located? __________________________________________________________
Type of cage: ______________________________
Cage substrate: __________________________
Size of Cage: ____________________________
Galvanized?
N
Y
How often is the cage cleaned? ________________________________________
What type of disinfectant is used to clean cage? _____________________________________________________________________
What type of lighting do you use?
Bulb
UVA/UVB
Fluorescent not UVA/UVB Other ___________________________
Heat source? _________________________________________________________________________________________________
Type of toys / perches offered: __________________________________________________________________________________
____________________________________________________________________________________________________________
Any other pets?
Pets are housed:
N
Y If yes, please specify: ___________________________________________________________________
Single
Together
If not housed together, where are the other pets located? ___________________________
Any new additions to the pet population?
N Y
If yes, please specify: _______________________________________________
Were new additions quarantined from the rest of the pets before introduction?
N
Y
For how long? ____________________
Nutrition
Types of food offered: _________________________________________________________________________________________
Pellets? N Y
Seed? N Y
Fruits? N Y
Veggies? N Y
Types of supplements/treats offered: ______________________________________________________________________________
Water source: Bowl Bottle
How often is water changed? _____________________________
Past Medical History / Problems:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Current Presenting problems: _______________________________________________________________________________
____________________________________________________________________________________________________________