Ferret History Form Thank you for choosing Ness Exotic Wellness Clinic. In order to personalize your experience and have a clear understanding of your pet's current health status, we need you to fill out the history form below.Today's dateGender:MaleFemaleUnsureNeutered:YesNoIs this your first Ferret?YesNoIs this your first PET?YesNoDate of Birth:ActualEstimatedDate Acquired:Acquired from what source?Pet StoreShelterPet ShowBreederPrivate PartyOtherENVIRONMENTIndicate Height, Width & LengthSubstrateNewspaperCare FreshYesterday’s NewsWood Shavings (cedar – pine)NothingOtherDoes the ferret use a litter box?YesNoCage Accessories:Sleeping BagHammockTowelsClimbing ToysShelvesCage Toys:Play TubesChew ToysExercise WheelOtherIs cage shared with another ferret?YesNoGender of Cage Mate?MaleFemaleUnsureAre they exposed to this pet?YesNoPlease indicate total minutes.Is your pet supervised when it is outside of its cage?YesUsuallyNoNUTRITIONDietVitamin & Mineral Supplements:MEDICAL HISTORYPlease list any medical problems/Primary Complaint:Current treatments or supplements:Please list any previous medical problems:VaccinationsDistemper?YesNoWhen?Rabies?YesNoWhen?Other Vaccines and/or ANY adverse effects?Current Appetite:NormalIncreasedDecreasedAnorexicHave you noticed:[checkbox haveYouNoticedVaccinationsFerret use_label_element "Weight Loss" "Weight Gain" "Masses or Lumps (indicate location below)" "Abnormal Urination" "Abnormal Stools" "Vomiting" "Other Discharge (describe below)" "Difficult Breathing" "Coughing" "Sneezing" "Nasal discharge (describe below)" "Excessive Shedding" "Hair Loss" "Itching" "Skin Sores (indicate location below)" "Lethargy" "Inactivity" "Deep Sleep" "Pain (indicate location below)"]Describe details from above or other changes:Former Vet VisitsYesNoDate of last visit:Records RequestedYesNoReceivedYesNoPrevious Lab Tests / Diagnostics:YesNoDate of testing:Tests Conducted:Complete Blood CountChemistry ProfileFecal ExamBacterial CultureRadiographs (X-ray)Other Tests:Abnormal Results:Results Requested:YesNoSent to Clinic?YesNoYour Signature To the best of my knowledge, the information provided above and on the patient history form is accurate and complete. I authorize you to contact my referring veterinarian if clarification of medical history is needed or to acquire previous veterinary records, I understand that payment is due at the time services are rendered. I agree to pay all charges at the time my pet is discharged.Data Privacy and Consent:I agree to theterms of service