Exotic History Form

Tell us all about your exotic pet!

The information you provide on this form can aid in helping the doctors diagnose your pet’s condition faster and more accurately. Please answer each question with as much detail as possible. Thank you. When filling out the form below, please keep in mind that a response usually takes 24-48 hours. If you are seeking a more immediate response, please call us during our regular business hours at 281-495-9445.

DOWNLOAD FORM

Date *

Pet Parent *

First

Last

Email *

Phone *

Previous Veterinarian *

Name of Pet *

Species

Age

Color

Are they a pet or breeder? *

Pet
Breeder

Length of time owned *

Where did you acquire your pet? *

Breeder
Petstore
Other

Please explain

How often is your pet handled? *

Daily
Occasionally
Never

Where is your pet housed? *

Indoors
Outdoors

What type of housing is your pet kept in?

Size of house?

What type of bedding?

What type of heat source?

What is the average temperature in your pet's house?

List all the foods that you offer your pet. (Be specific)

Amount and frequency fed?

Of all of the foods listed above, which does your pet eat on a routine basis?

Does your pet receive any vitamins or mineral supplements? if so, what and how often are they offered?

What is the source of your pet's water?

Does your pet have any history of previous diseases, injuries or parasitic infections?

Do you have any additional information concerning your pet's health?

Social Media Authorization - ABC likes to share interesting stories or cute photos of our GREAT patients on Facebook or other approved social media. *

I agree to have my pet's photo shared on social media.
I do not agree to have my pet's photo shared on social media.

Message

Facebook
Instagram