Ferret History Form

PATIENT INFORMATION

Date

Name*

Species

Breed

Date of Birth

Gender

Male
Female
Unknown

Spayed / Neutered:

Yes
No

Where did you obtain your Ferret?

Breeder
Pet Store
Friend/Family
Rescue
Found/Caught

How long have you had your Ferret?

What other pets are kept in the house and do they interact?

Are any of the other pets new (within the last 6 months)?

ENVIRONMENT

What type of enclosure does your ferret live in?

What are the dimensions of the enclosure?

Height

Width

Length

What type of material is used to line the bottom of the cage?

Is there a litter pan in the enclosure?

Is your ferret kept inside or outside?

Do other animals share the cage?

How is water offered?

Dish
Water Bottle

How often is water changed?

How much time does your pet spend outside the cage/habitat?

Is this time supervised?

Does your pet chew on carpet or other objects/materials when outside the cage?

Please list any recent changes to the environment, if any:

DIET

What do you feed your ferret (include how much is actually eaten, not how much is offered)?:

A. Kibble

B. Live/Frozen prey:

C. Fruit

D. Vegetables

E. Treats (brand and amount)

F. Other (include amount and type)

How often do you feed your pet?

How often does your pet defecate?

Are you offering any type of supplements, how often are they offered and how are they offered (in food, water or other)?

REASON FOR VISIT TODAY

What is the primary complaint or what signs have you noticed?

How long have these problems been present?

How is your ferret’s appetite?

How is your ferret’s activity level?

Have you noticed any of the following (circle any that apply)?

Weight loss
Increased breathing rate or effort
A change in the droppings
Abnormal skin color or shedding
Parasites on the skin or in the feces
Weight gain
Discharge from the eyes or nose
Weakness

What conditions, problems or operations has your pet had previously (list the date if it is known)?

Has your ferret received any vaccinations in the past, when were they given and any vaccine reaction?

Rabies
Distemper
Other

Other:

If your ferret on heartworm prevention and when was it last given?

Has your pet received any treatment in the last 30 days?

Yes
No

If yes, please give details (what was used, dosage, duration, frequency, etc.)

Have you noticed any changes in your pet’s behavior?

Have any other animals in the household had any illness in the last 30 days?

Yes
No

If yes, please describe:

PATIENT INFORMATION

ENVIRONMENT

What are the dimensions of the enclosure?

DIET

REASON FOR VISIT TODAY

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