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847-647-9325
7278 North Milwaukee Niles, IL 60714
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Small Mammal History
Step 1 of 5
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Owner's Name
*
First
Last
Name of Pet (s)
*
Species
*
Age
*
Sex
*
Male
Female
Unknown
How long have you been keeping this species of pet?
*
How long have you had this pet(s)?
*
Purpose of visit
Previous Veterinary (if any)
If illness, describe signs, duration, and severity
Coughing
Yes
No
Sneezing
Yes
No
Vomiting
Yes
No
Diarrhea
Yes
No
Lameness
Yes
No
Scratching
Yes
No
List exisiting or previous medical conditions
List any medications given to the pet(s) named above
Diet - What is offered and what is eaten (iclude brand names, frequency of feeding and method of feeding
Supplements or vitamins
Water:
Dish
Bottle
How often is container refilled?
How often is container cleaned?
Housing
Size and type of cage
Type of bedding
Frequency of cleaning
Keep alone or with how many others?
Exercise
Method
Frequency
Handling
How often?
By whom?
Other pertinent information
Δ
New Clients
Request an Appointment
Forms
About Us
Locations & Hours
Team
Emergency Information
AAHA Accreditation
Veterinary Career Information
Join Our Team
Question/Answer Form
Pet Poems, Quotes and Stories
Our Services
Behavior Consultations
Preventive Health Care
Diagnostic / Laboratory Services
Dentistry
Wellness and Vaccination Programs
Exotic Pet Medicine and Surgery
Pet Bird Medicine
Surgical Services
Additional Services
Pet Health
Avian Articles
Educational Articles
How-To Videos
Pet Health Checker
Pet Insurance
Product Recalls
Pet Food Recalls
Articles (NAH)
Videos (NAH)
News
Links
Online Pharmacy
Mobile App
facebook
youtube