Small Mammal 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 Species:Guinea PigChinchillaDeguHamsterGerbilRatMouseSugar GliderHedgehogOtherGender:MaleFemaleUnsureNeutered:YesNoIs this your first Small Mammal?YesNoFirst of this type?YesNoDate of Birth: ActualEstimatedDate Acquired:Acquired from what source?Pet StoreShelterPet ShowBreederPrivate PartyOtherENVIRONMENT Indicate Height, Width & Length OR Gallons.SubstrateCare FreshYesterday’s NewsWood Shavings (cedar – pine)Hardwood Chips (aspen – walnut)NewspaperOther Cage Accessories:Sleeping Box - HouseClimbing ToysShelves - LevelsCage Toys:Exercise WheelPlay TubesChew ToysOtherIs cage shared with another animal?YesNoGender of Cage Mate?MaleFemaleUnsure Are they exposed to this pet?YesNo How much time does your pet get out of its cage per day?Is your pet supervised when it is outside of its cage?Yes (always)UsuallyNoNUTRITIONDiet Vitamin & Mineral Supplements:MEDICAL HISTORYPlease list any medical problems/Primary Complaint:Current treatments or supplements:Please list any previous medical problems:Current Appetite:NormalIncreasedDecreasedAnorexicPlease describe duration, progress & severity:Stools: Urination: Have you noticed:Describe details from above or other changes:Previous Vet VisitsYesNo Date of last visit: Records RequestedYesNoReceivedYesNoPrevious Lab Tests / Diagnostics:YesNoDate of testing:Tests Conducted:Complete Blood CountChemistry ProfileFecal ExamUrinalysisBacterial CultureRadiograph (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 the terms of service