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Home
Our Hospital
Our Doctors
Hospital Tour
Forms
Careers
Download Our PetDesk App
Services
Dental Care
Laser Therapy
Wellness Exams
Senior Wellness
Digital Radiology
Ultrasound
Pocket Pets
View All Services
New Clients
Payment Options
Shop Online
Contact Us
Make An Appointment
414-425-2339
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Guinea Pig History Form
Guinea Pig History Form
"
*
" indicates required fields
Owner's First Name
*
Owner's Last Name
*
Phone Number
*
Patient Name
*
Age
*
Sex
*
Male
Female
Has your guinea pig been spayed/neutered?
*
Yes
No
Breed
*
Color
*
Does your pet have a microchip?
*
Yes
No
If yes, please provide Microchip ID
*
Has your guinea pig been to a veterinarian before?
*
Yes
No
If so, where?
*
Reason for your visit
*
Wellness
Sick
Tell us more
*
Tell us a little bit about what is going on with your pet.
*
Coughing
Sneezing
Diarrhea/change in stool pattern
Nasal Discharge
Eye discharge or bulging eyes
Scratching or hair loss
Limping
Abnormal Urination
Changes in appetite
Other
Please select all that apply
If other, please specify
*
Your Pet's History
Where did you get your guinea pig?
*
Pet Store
Breeder
Private Party/Friend
Other
If other, please specify
*
How long have you had your guinea pig?
*
Has your guinea pig had any history of medical issues?
*
Yes
No
If yes, please specify
*
Is your guinea pig currently on any medications, supplements, or preventatives?
*
Yes
No
If yes, please list all medications, supplements, and preventatives
*
Please list dosage and amount
Housing
What type of enclosure do you keep your guinea pig in?
*
What type of bedding do you use & how often is it changed?
*
Where is the enclosure located?
*
What types of toys/enrichment does your guinea pig have in their enclosure?
*
Are there any other pets in your home that have contact with your guinea pig?
*
Diet
What type of food(s) do you offer your guinea pig?
*
Amount fed
*
Have there been any recent changes in diet?
*
Yes
No
If yes, please describe
*
What type of water do you provide your guinea pig?
*
Sipper/Drip bottle
Bowl
How often is the water source cleaned?
*
A Day in the Life
What does a day in your guinea pig's life look like?
*
Are they allowed to roam the house? Supervised or unsupervised?
Are they allowed outside? Leashed or out door enclosure, supervised or unsupervised?
Is there anything else you'd like us to know about your guinea pig?
*
Signature
*
Phone
This field is for validation purposes and should be left unchanged.
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