Exotic Pet Appointment Form

Patient Information:

Pet's Name

Type of Animal

Guinea Pig

Ferret

Rabbit

Rodent

Reptile

Chicken

Breed

Age / DOB

Sex

Color/Markings

Date Acquired & From Where

Habitat Information

Housing

Material/Dimensions

Substrate/Bedding

Heat Source(s)

Light Source(s)

Nutrition Information

Diet (Items, Proportions, Frequency, Supplements, Time of Last Feeding)

General Information

Previous Veterinarian and Phone Number

How did you hear about us?

Internet Search

Drive By

Client Referral

Other

If you were referred by a client, what is their name?

I understand that my pet’s picture may be used on social media sites.

YES, you can use my pet's photo on social media.

NO, do not use my pet's photo on social media.

Exotic Pet Appointment Form

Patient Information:

Pet's Name

Type of Animal

Breed

Age / DOB

Sex

Color/Markings

Date Acquired & From Where

Habitat Information

Housing

Material/Dimensions

Substrate/Bedding

Heat Source(s)

Light Source(s)

Nutrition Information

Diet (Items, Proportions, Frequency, Supplements, Time of Last Feeding)

General Information

Previous Veterinarian and Phone Number

How did you hear about us?

If you were referred by a client, what is their name?

I understand that my pet’s picture may be used on social media sites.

Current Problem (Describe Clinical Signs Subjectively)