Exotic Animal Information Check In Sheet

Owners Name
_________________________________________________________________________
Primary Caretaker of pet
_________________________________________________________________
General Information
Pets Name _____________________________________________
Species _______________________________ Breed (if applicable)
_____________________________
Age (if known) _________________________

Age @ acquisition ______________________________

If age is unknown was the animal adult or

juvenile

when it was acquired?

When & where acquired

_________________________________________________________________
Sex (if known)

Male

Female

Intact

Neutered

Bird and Reptile- Method of determination of sex- DNA Surgical Probe Other __________________
Colors/Marking
_________________________________________________________________________
Housing
Cage type and material (i.e. glass aquarium, wooden hutch, etc.)
_________________________________
Solid or Mesh flooring

Approximate cage dimension _________ h X _________ w X ________ d

Location of cage
________________________________________________________________________
Bedding / substrate __________________________ How often is bedding replaced _________________
Light source(s) __________________________ Heat source(s)
__________________________________
Temperature cage is kept at- Daytime ____________________

Night time _______________________

How often is cage cleaning & with what

_____________________________________________________
How often are food and water bowls cleaned and with what _____________________________________
Object in cage (i.e. perches, logs, ladder, hammocks)
__________________________________________
Toys and how often replace
______________________________________________________________

Litter box trained

Yes

No

Any expose to natural sunlight

Kind of litter ________________________________________

Yes

No

If yes, how much? ________________________

Amount of time spent out of cage

__________________________________________________________
Amount of time you or primary caretaker spends with pet ______________________________________
How often is animal misted or soaked if appropriate ___________________________________________
Last moult if appropriate and any issues
_____________________________________________________
____________________________________________________________________________________
__

For Ferrets Only

Date of last distemper vaccine _________________ Date of last rabies vaccine ___________________
On heartworm prevention Yes / No What kind ________________ Last heartworm test ___________
Feeding
Brand or type of food (please list everything that your pet eats)
____________________________________________________________________________________
____________________________________________________________________________________
____
Reptile- Live or Prekilled prey-(fish or frozen) If crickets/mealworm- are they gutloaded- Yes No
Where food is purchased __________________ Treats _______________ Supplements
_____________
Other Information
Any other animals in household
Animal Name

Yes

No

Species / Breed

If Yes, please list below

Age

Healthy?_______________

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
______
Any cage mates
Yes No
Has the pet come into contact with any other animals lately Yes
No
Has anyone in the household come into contact with any other animals lately (i.e. handing animals at a
pet store or friends house) Yes No
For sick visit

Current problem
________________________________________________________________________

_________________________________________________________________________________________
_
_________________________________________________________________________________________
_
____________________________________________________________________________________
__
When did problem start / when was it first noticed ____________________________________________
Has pet had nay (circle all that apply)

Coughing

Sneezing

from nose or eyes

Lethargy

Decrease appetite

Constipation

Vomiting

Diarrhea Discharge

When did the animal last eat ____________________________ Last bowl moment
__________________
Has any treatment at home been given for this problem

Yes

No

______________________

____________________________________________________________________________________
__
Has the animal ever been seen by another vet for this problem or any other problems? Yes No
If yes, when and where
__________________________________________________________________
Any past medical problems
_______________________________________________________________