Health Risk Assessment - Rabbits, Guinea Pigs & Chinchillas
Hello! Please help us expedite your check-in process, decrease your wait time, and offer you the best medical care during your Preventative Healthcare Plan Exam, Annual Examination, or Complete Physical Exam, by completing this history form prior to your appointment. You can complete it by yourself, with other family members or in the office, but with a little advance planning we can help lead your attending DVM to develop the best plan for your pet's ongoing healthcare.
Email address *
First & Last Name of Pet Owner *
Your answer
Pet's Name *
Your answer
Updated Contact Information
If you have moved within the last year, or if your phone number or primary email address has changed, please let us know so we can update your records.
Your answer
Does Your Pet Have A Photo On File? *
If you know your pet's photo has been updated, please select "Yes." If you would like to submit a new photo, please send your photo online to, or we we'll be happy to take a picture with a fresh look for your on the day of your appointment.
How did you obtain your Pet?
Length of Relationship With Your Pet?
How long have you known the ferret, and how long have you owned him/her? If your ferret is not new to HVC, you can skip ahead to the next question.
Your answer
Time with People *
Please describe the average amount of time your bird spends interacting with people per day/week etc.
Your answer
House Rules *
Please check all that apply:
Time out of Enclosure *
If your pet spends most of his/her time in an enclosure, please state the average amount of time your pet spends outside of his/her enclosure(s) per day/week etc. If your pet free roams, type "N/A"
Your answer
Are Any of Your Pet's Enclosure(s)
Select all that apply
Flea Prevention
If you indicated that you administered any flea prevention to your pet, and you did not obtain this product via HVC, please state what kind of prevention was used and when that administration last occurred. If you are unaware of any prevention being administered state "unsure." if you have not administered any prevention, state "none."
Your answer
Current Medications *
If your pet is taking any prescription medications, please list the type and dosage below. For example, if your pet receives meloxicam liquid, you might type "Loxicam 1.5mg/ml - dosage on file." If your pet was prescribed medication previously, but no longer takes the medication, or if the dosage has been adjusted by a veterinarian or at home, you may comment below as well. If your pet takes no medications, simply comment "None" or "N/A"
Your answer
Refills Needed? *
If your pet will need refills today please indicate how we can help:
Your answer
Never submit passwords through Google Forms.
This form was created inside of Report Abuse - Terms of Service