Small Rodent Questionnaire
Owner’s Name:
Date:
Email address:
Pet’s Name:
Species:
Sex: male
Age or Birthday
1. How did you acquire your pet?
2. What type of food do you feed your pet? How much do you feed?
Rodent pellets
Fruits & Vegetables
Seed mix
% of diet
cup/day
% of diet
Other
3. Does your pet drink from a bottle or a bowl? bottle
4. Does your pet use a litter box? yes
5. How much time does your pet spend in its cage?
6. How often do you clean your pet’s cage?
7. What do you use for bedding?
8. Does your pet go outside? yes How much time is spent outside?
9. Do you groom your pet (i.e. trim nails, brush fur)? yes How often?
10. Does your pet have any contact with other pets/animals inside or outside of the home? yes
11. Has your pet been spayed or neutered? yes
12. Has your pet been to a veterinarian before? yes
If yes, when/where?
13. Does your pet chew on things that he/she should not chew on? yes
14. Has your pet ever had his/her teeth trimmed? yes
If yes, when/where?
15. Has your pet had any wet, clumped fecal matter? yes How often do you notice it?
16. Have you noticed any of the following:
scratching
flakey skin
lumps or bumps
changes in
sneezing and/or
behaviour
coughing
change in eating
and/or drinking habits
runny eyes/nose
teeth grinding
changes in urine or
stool (fecal ball)
production
size of fecal balls
17. If yes to any of the above, when did you notice this?
18. Do you have any other health issues or concerns you would like to discuss with the veterinarian?
How did you hear about our hospital?
website or internet search
referral from client
Yellow Pages
Other