Client Forms

Thank you for choosing Fisher Glen Animal Hospital

Our team will be in touch with you within 24-48 hours.

New Client Form
Exotic Health History – Pocket Pets/ Rabbits/ Chinchillas
Exotic Health History – Reptiles
Exotic Health History – Avian

New Client Form

Owner Information

Full Name(Required)

Co-Owner Full Name

Phone(Required)

Email(Required)

How did you hear about us?(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code

Pet Information

Pet's Name(Required)

Date of birth/Age

Species(Required)

Breed

Sex(Required)

Neutered/Spayed?(Required)

Colour

Previous Veterinarian:

Do we have permission to contact your previous clinic to get your pets records

Yes

Date of last vaccines (if applicable)

What vaccines were given? (if applicable)

Is your pet on any medication or supplements?

Does your pet have/had a medical condition?

Does your pet have any allergies or drug reactions?

Pet Insurance Company

Pet Insurance Policy #

Additional notes about your pet

May we email or call you with appointment/vaccine reminders?(Required)

Yes

Consent Signature (Your Name)

If you give consent to the above, please provide your name and pet’s name so that we can appropriately credit you and your pet!

Consent Signature: Pet's Name

Exotic Health History – Pocket Pets/ Rabbits/ Chinchillas

Brought in by (Owners name):

What is the main reason for today's visit?

Any concerns?

Does your pet board?

Is this your only pet? If no, what other pets do you have?

When is the last time your pet was seen by vet?

Is your pet indoor, outdoors or both?

Is your pet eating and drinking normally?

What is your pet currently eating?

Does your pet get treats?

Does your pet get any supplements?

Does your pet get any fresh fruits or veggies?

Does your pet drink from a bottle or a bowl?

What is the size of your pets cage?

What furniture/toys are available?

Does your pet get time out of their cage? If so, how many hours a day on average?

Does your pet have access to chew toys?

Does your pet have a history of chewing things they shouldn't?

What type of bedding is used in the cage?

How often is the bedding changed?

Is your pet litter trained? What type of litter do you use?

CHINCHILLA: Does your chinchilla get dust baths?

Have you noticed any of the following signs or symptoms?

Flakey skin

Teeth grinding

Runny eyes/nose

Change in size, consistency or frequency of bowl movements

Change in urinary habits

Scratching

Lumps or bumps

Sneezing and/or coughing

Changes in behaviour

Exotic Health History – Reptiles

Brought in by (Owners name):

What is the main reason for today's visit?

Any concerns ?

Is your reptile eating and drinking normally?

What is your reptile currently eating?

How often is your reptile fed?

Does your reptile get any fresh fruit/veggies?

Does your reptile get any treats?

Does your reptile get any table scraps?

Does your reptile get vitamins/calcium supplement? What brand and how often?

How is your reptile housed?

What substrate (bedding) do you use?

Does your reptile have a basking spot?

Does your reptile have a full spectrum or UV light?

What is the temperature & humidity in the terrarium during the day?

What is the temperature & humidity in the terrarium during the night?

Has your reptile laid any eggs? When was the last clutch laid?

When was your reptiles last shed?

Is your reptile showing any of these signs or symptoms?

Change in stools or constipation?

Breathing difficulty?

Discharge from eyes or nose?

Weakness?

Swelling, bleeding or injury?

Abnormal behaviour?

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Thank you for choosing Fisher Glen Animal Hospital

New Client Form

Exotic Health History – Pocket Pets/ Rabbits/ Chinchillas

Exotic Health History – Reptiles

Exotic Health History – Avian

New Client Form

Owner Information

Pet Information

Exotic Health History – Pocket Pets/ Rabbits/ Chinchillas

Exotic Health History – Reptiles

Exotic Health History – Avian