Small Rodent Health Questionnaire Form Owner’s NameDate Date Format: MM slash DD slash YYYY AddressPostal CodePhone numbers (home)(cell)(work)Email Emerg. Contact(other than immediate family):ph:Pet’s NameBreedColourSexMaleFemaleNeuteredSpayedAge or BirthdayHow did you acquire your pet ?What type of food do you feed and how much do you feedRodent pellets% of dietSeed mix% of diet or cup/day Fruits & Vegetables cup/dayOtherDoes you pet drink from a bottle or bowl?Does your pet use a litter box?How much time does your pet spend in its cage?How often do you clean your pet ’s cage?What do you use for bedding?Do you groom your pet ? (i.e. trim nails, brush fur)? How often?Does your pet have any contact with other pets/animals inside or outside of your home?Has your pet been to a veterinarian before?If yes, when/where?Does your pet chew on things that he/she should not chew on?Has your pet ever had his/her teeth trimmed?If yes, when/where?Has your pet had any wet, clumped fecal matter? How often do you notice it?Have you noticed any of the following;scratchingflakey skinteeth grindinglumps or bumpsrunny eyes/nosesize in fecal ballssneezing and/or coughingchanges in behaviourchanges in eating and/or drinking habitschanges in urine or fecal ball productionIf yes to any of the above, when did you notice this?Do you have other health issues or concerns you would like to discuss with the veterinarian?EmailThis field is for validation purposes and should be left unchanged.