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Small Mammal Questionnaire Animal Medical Center of Tyler

Save time at your next appointment! Please complete your required small mammal questionnaire online from any device at any time before your visit.

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Small Mammal Questionnaire

Please complete this form completely and accurately so that we can get to know you and your pet(s) before your visit. If this is an emergency or your pet requires immediate attention, please call us at (903) 617-6891 for a faster response.

**Please bring a fresh fecal sample to your appointment.**
Pictures of your pet’s enclosure can be sent to amctyler@gmail.com

Client Name *

First

Last

Pet Name *

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Species *

Breed *

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Sex *

Male
Female
Unknown

Approximate age/DOB *

When did your pet last eat? *

When did your pet last drink? *

When did your pet last urinate/defecate? *

Has your pet ever been fecal tested? *

Has your pet ever received any vaccines? *

How long have you owned your pet? *

Where did you acquire your pet? *

Have you owned a small mammal previously? *

How often is your pet handled? *

How often is the enclosure cleaned? *

What products do you use to clean? *

Environment

Enclosure Dimensions

Substrate Type

Enclosure Location

How often is the substrate changed or cleaned?

What other enrichment items are in the enclosure?

Have there been any environmental changes in the last 30 days?

Does your pet go outside?

Do you bathe your pet?

Does your pet share an enclosure with cage mates?

Is your pet allowed time outside of their cage?

Have there been any environmental changes in the last 30 days?

Diet

Please specify brands and amounts.

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How often do you feed your pet?

What time of day?

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Is any left over after feeding? How much and what type?

Are you providing any vitamin or mineral supplements? How often?

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How do you provide water? (Bowl, bottled, tap, shower)

How often are you changing the water?

Is your pet exposed to smoke from:

	Yes	No
Cigarettes	YesCigarettes Yes	NoCigarettes No
E-Cigarettes	YesE-Cigarettes Yes	NoE-Cigarettes No
Marijuana	YesMarijuana Yes	NoMarijuana No
Fire	YesFire Yes	NoFire No
Wood-Burning Fire	YesWood-Burning Fire Yes	NoWood-Burning Fire No
Scented Candles	YesScented Candles Yes	NoScented Candles No
Incense	YesIncense Yes	NoIncense No
Aerosols	YesAerosols Yes	NoAerosols No

Additional Information

What are your concerns for your pet today? Please specify the issue(s), when it first started, any treatments being administered and any husbandry changes.

Has your pet had any prior known health issues? Please specify the duration of the issue, when it started (if known) and any treatments provided.

Has there been any of the following:

	Yes	No
Nasal or ocular discharge?	YesNasal or ocular discharge? Yes	NoNasal or ocular discharge? No
Coughing or sneezing?	YesCoughing or sneezing? Yes	NoCoughing or sneezing? No
Excessive drinking?	YesExcessive drinking? Yes	NoExcessive drinking? No
Excessive scratching?	YesExcessive scratching? Yes	NoExcessive scratching? No
Odd positioning or loss of use in any limb?	YesOdd positioning or loss of use in any limb? Yes	NoOdd positioning or loss of use in any limb? No
Abnormal vocalizations?	YesAbnormal vocalizations? Yes	NoAbnormal vocalizations? No

Are the droppings normal in size and appearance?

Is the skin normal?

Small Mammal Questionnaire Animal Medical Center of Tyler

Small Mammal Questionnaire

Environment

Diet

Additional Information

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