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Loving Family Vet - RABBIT/RODENT LIFESTYLE ASSESSMENT
1
Name
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2
Email
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example@example.com
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3
Age
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4
If unknown circle one
Adult
Juvenile
Baby
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5
Sex
Male
Female
Unknown
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6
Neutered
Yes
No
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7
Cagemates (exposure to other pets)
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8
Cage Dimensions
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9
Cage construction/materials (circle all that apply):
Glass (aquarium)
Glass (view window)
Wood (treated)
Wood (untreated)
Plastic
Concrete
Sheet Metal
Particle Board
Chain Link Fence (yard enclosure)
Cinder Block
Brick
Fiberglass
Metal window screen
Plastic window screen
Other
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10
If Other, Explain
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11
Cage furniture (circle all that apply)
Hide box
PVC Pipe
Cork bark
Branch
Wood
Water bowl
Plastic bottom/wire
Litter box
Other
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12
If Other, Explain
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13
How often is cage cleaned?
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14
How often is cage disinfected?
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15
Disinfectants used?
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16
Temperature of cage area?
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17
Any time outdoors?
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18
DIET
List all food items offered and their approximate percentage of total diet
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19
Frequency of feeding
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20
How is food stored?
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21
Diet Supplements if any
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22
Last parasite exam
Results
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23
Any past illnesses?
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24
Any past vaccines?
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