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Rabbit and Guinea Pig History Intake Form
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Client Name
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Email
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Phone Number
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Please list previous veterinary hospitals for records. Put "N/A" if not applicable.
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Patient Name
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Patient Age
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Appointment Date
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Where did you get your pet and how long ago?
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Does your pet have any exposure to and/or live with other animals? If yes, please list species and if they interact with each other.
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What are you currently feeding your pet? Please list brand, how much and how often you are feeding per day.
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Do you give your pet any medications or supplements? If yes, please list medication name, strength, and how often it is given.
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How do you house your pet and how often is their area cleaned? Please include what type of litter/bedding you use.
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How is your pet’s appetite?
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Any soft stools or diarrhea?
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Has there been any change in your pet’s water intake or urination? If yes, please list when the symptoms started, how frequent and descriptions.
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Any sneezing or changes in breathing?
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How is your pet’s energy level?
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Is your pet having any problems with lameness or stiffness? If yes, please list when the symptom started, how frequent and descriptions.
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Is there anything in your pet’s history we need to be aware of? Please list chronic issues, surgeries, irregular blood work, diagnoses and medical conditions.
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Do you have any concerns about your pet today? If yes, please explain.
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