Ferret Health Questionnaire Form Date MM slash DD slash YYYY Owner’s Name:Pronouns (optional)Address Street Address City Province/Region Postal Code Phone (home)Phone (cell)Phone (work)Email Emergency Contact (other than immediate family)PhonePatientPet’s NameAgeBirthday MM slash DD slash YYYY BreedColourGender Male Female Unknown Neutered Spayed How long have you had your ferret?From where did you acquire your ferret?Is your ferret vaccinated? Yes No Date of last vaccine: DistemperDate of last vaccine: RabiesHas your ferret ever had an adverse reaction to a vaccination? Yes No If yes, provide further detailsIs your ferret on heartworm preventative? Yes No If yes, indicate product and frequencyHousingHow is your ferret housed? Cage Free in room Free in home Other OtherWhat are the dimensions of their enclosure?What materials do you use for hideouts and bedding?Does your ferret use a litterbox? Yes No If yes, what type of litter do you provide?How often do you clean your ferret’s cage, and/or change the litter/bedding?What cleaning agents are used?How much time do they get to explore outside their area daily?Do you provide UVB lighting for your ferret? Yes No If yes, what type of light is used and how often is it changed?Does your ferret go outside? Yes, supervised Yes, unsupervised No If yes, please provide detailsWhat types of enrichment toys do you provide your ferret?Do you have other pet(s) in the household? Yes No If yes, list the number of pets and speciesDietPlease list all food items your ferret consumes, as well as amount fed:Dry Food (brand?)Wet Food (brand?)Meat/prey (type)Treats/OtherDoes your ferret drink from a Bottle Bowl Fountain Other OtherWhat foraging opportunities do you provide for your ferret during mealtimes?Health & FitnessDoes your ferret allow you to perform any of the following grooming procedures? Trim nails Brush teeth Clean ears Bath Other (check all that apply)OtherHas your ferret had any previous health issues requiring medical, or surgical treatment? Yes No If yes, please provide further detailsIs your ferret currently on ANY supplement or medication (incl. glucosamine, vitamins, probiotics, etc)? Yes No If yes, please indicate how often and amountsHave you noticed any changes in water consumption? No change Increased drinking Decreased drinking Have you noticed any of the following changes in eating habits? Changes in eating habits Difficulty eating Dropping foods Vomiting Drooling (check all that apply)Have you noticed any of the following changes to their urine or fecal production? Increased urination Decreased urination Change in litterbox habits Diarrhea, or straining to eliminate (check all that apply)Have you noticed any of the following symptoms in your ferret? Scratching Hair loss Lumps or bumps Runny eyes/nose Sneezing and/or coughing Odour changes Weight loss Lameness or change in mobility Changes in behaviour Weakness, glazed eyes Salivation, pawing at the mouth Fainting, collapse or shortness of breath (check all that apply)Do you have any specific questions or concerns?