Small Mammal Questionnaire

Owner Information

Name

Phone number

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Email address

Address

Preferred contact method

Radio options for Preferred contact method

Phone Email

Pet Information

Pet's name

Species

Breed

Age

Sex

Radio options for Sex

Male Female Unknown

How long have you had your pet?

Where did you acquire your pet?

Radio options for Where did you acquire your pet?

Breeder Pet Store Rescue Other

Diet & Nutrition

What type of food do you feed your pet?

Radio options for What type of food do you feed your pet?

Pellets Fresh Vegetables Hay Insects Fruit Other

Please list specific brands or types of food

How often do you feed your pet each day?

Do you offer fresh water daily?

Please select… Yes No

Do you provide any supplements?

Please select… No Yes

Housing & Environment

What type of enclosure does your pet live in?

What are the dimensions of the enclosure?

Do you use any bedding or substrate?

Please select… No Yes

If yes, what type?

How often is the enclosure cleaned?

Where is the enclosure located in your home?

For example - Near a window, In a quiet area, Near a kitchen, etc.

How much time does your pet spend outside the enclosure daily?

Are there other pets in the household?

Please select… No Yes

If yes, what kind?

Behaviour & Socialisation

How would you describe your pet’s personality?

Does your pet have any known behavioural issues?

For example - Self-barbering, Chewing on bars, Excessive vocalization, Biting, etc.

Health & Medical History

When was your pet’s last veterinary visit?

Has your pet ever been diagnosed with any medical conditions?

Has your bird ever been tested for infectious diseases?

Please select… No Yes If applicable for the species

Has your pet ever been on any medications?

Please select… No Yes

If yes, please list them

Does your pet show any of the following symptoms?

Sneezing Discharge from eyes/nose Hair loss or skin issues Changes in droppings (colour, consistency, frequency) Changes in appetite or water intake Weakness or lethargy Difficulty breathing Unusual posture or gait Vocalisation changes Lameness or difficulty moving Other (please specify below)

More information

If you have selected "Other" above, please let us have more details

Reproductive History

(for applicable species)

Has your pet ever been bred or produced offspring?

Please select… No Yes

If yes, when was the last time?

Does your pet show signs of hormonal behaviour?

Please select… No Yes For example - excessive nesting, aggression, regurgitation, etc.

Additional Information

Any other information

Is there anything else we should know about your pet’s health, behaviour, or environment?

Send