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 date

    First Name

    Last Name

    Work Phone

    Cell Phone

    Home Phone


    Pet's Name



    Is this your first Ferret?

    Is this your first PET?

    Date of Birth:

    Date Acquired:

    Acquired from what source?


    Approximate Cage Dimensions:

    Indicate Height, Width & Length


    Does the ferret use a litter box?

    Which Litter is Used?

    How often is the cage cleaned?

    Cage Accessories:

    Cage Toys:

    Is cage shared with another ferret?

    Gender of Cage Mate?

    Other pets in the home:

    Are they exposed to this pet?

    In what way?

    How much time does your ferret get out of its cage per day?

    Please indicate total minutes.

    Is your pet supervised when it is outside of its cage?


    Diet (Please describe in detail)

    List everything the ferret eats:

    Vitamin & Mineral Supplements:


    Please list any medical problems/Primary Complaint:

    Current treatments or supplements:

    Please list any previous medical problems (Please Indicate Dates % Treatments):




    Which Product?



    Which Product?

    Other Vaccines and/or ANY adverse effects? (Please include when given.)

    Current Appetite:

    Have you noticed:

    Describe details from above or other changes:

    Former Vet Visits

    Doctor's Name

    Date of last visit:

    Doctor's Phone

    Doctor's Clinic

    Records Requested


    Previous Lab Tests / Diagnostics:

    Date of testing:

    Tests Conducted:

    Other Tests:

    Abnormal Results:

    Results Requested:

    Sent to Clinic?

    Your 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