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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
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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
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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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