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Guinea Pig History Form
Client Details
Name
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
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Armenia
Aruba
Australia
Austria
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Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
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Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
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Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
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Greenland
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Guinea
Guinea-Bissau
Guyana
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Holy See
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Indonesia
Iran
Iraq
Ireland
Isle of Man
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Madagascar
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New Caledonia
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Niger
Nigeria
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North Korea
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Norway
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Panama
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Paraguay
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Poland
Portugal
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Romania
Russia
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Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
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Samoa
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Slovenia
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Tanzania
Thailand
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Tonga
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Turkey
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Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
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Ukraine
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United Kingdom
United States
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Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Phone Number
Email Address
Guinea Pig Details
Name
Age (date of birth)
Sex
Male
Female
Is your guinea pig spayed or neutered?
Date acquired
Source (pet shop, friend, breeder, etc)
Details of Other Pets
Do you have any other guinea pigs? If yes, please provide details (name, date acquired, source, any known illness)
Do you have any other pets? If yes, please provide details (species, date acquired, source, any known illness)
Husbandry
Is your guinea pig kept in a cage indoors? If yes, please provide approximate dimensions
Please describe the bedding and litter used in the cage
Where does your guinea pig urinate and defecate?
Has your guinea pig damaged any household items? If yes, please provide details (item, how and when it was damaged)
Food
Please describe your guinea pig’s diet (Include pellets, any table food, treats etc.)
Has there been a recent change in diet? If yes, please specify
Are any of the following given to your guinea pig?
Vitamins
Minerals
Medicines
Probiotics
Tonics
Water
Does your guinea pig drink from a bowl or a sipper-bottle?
Have there been any changes in drinking habits for your guinea pig?
Has the drinking increased or decreased as of late? If yes, when did you notice?
The Presenting Health Concern
Has your guinea pig had any previous health issues? If yes, please provide details
Please describe your guinea pig’s clinical symptoms
Does the skin and fur appear normal?
Has there been any excessive scratching?
Has there been any nasal or ocular discharge? If yes, please provide details
Has there been any odd positioning or loss of use of any limbs? If yes, please specify
Has there been any abnormal vocalization?
Are your guinea pig’s droppings normal in appearance and size? If not, please provide details
Any additional comments
Δ
Home
About Us
Location & Hours
Team
Associated Veterinary Specialists
Continuing Education
Community Involvement
Our Patients
Success Stories
Send Us Your Photos
Services
Medical Services
Surgery Services
Emergency Care
Chiropractic Services
Specialty Services
Wellness and Preventative
Puppy and Kitten Exams & Vaccinations
Laser Procedures
Blood and Plasma Transfusions
Nutrition
Anesthetic Monitoring
Resources
Educational Articles
Educational Presentations
Pet Health Checker
Forms
Prescription & Food Refill
Referrals
Weight Loss Questionnaire
Feline Friendly
Exotic Care
Emergency
Emergency Procedures
Emergency Procedures – Dogs and Cats
Emergency Procedure For Your Pet Bird
Emergency Procedures For Your Reptile
Emergency Procedures – Small Mammals
Wildlife Emergency Procedures
Careers
Externship Opportunities