Client Details

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number

Email Address

Rabbit Details

Name

Age (date of birth)

Sex

Is your rabbit spayed or neutered?

Date acquired

Source (pet shop, friend, breeder, etc)

Details of Other Pets

Do you have any other rabbits? 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)

Indoor Rabbit Husbandry

Does your rabbit have access to the entire house? (If he/she is confined to one room, please provide details)

Is your rabbit kept in a cage indoors? If yes, please provide approximate dimensions

Please describe the bedding and litter used in the cage

Where does your rabbit urinate and defecate?

Do you provide full spectrum lighting – uva/b lights? If so when was it last changed?

Outdoor Rabbit Husbandry

Where is your rabbit’s hutch situated?

Are there any trees hanging over your rabbit’s hutch?

Is there shelter from predators?

Have you ever seen rats, mice, foxes, cats, or birds of prey in your garden? (If yes, please specify)

Please describe the vegetation in your garden

What type of litter do you use on the floor of your rabbits hutch?

Has your rabbit damaged any household items? If yes, please provide details (item, how and when it was damaged)

Food

Please describe your rabbit's diet (Include pellets, all snacks, treats and any food related item)

Has there been a recent change in diet? If yes, please specify

Are any of the following given to your rabbit?

Vitamins
Minerals
Medicines
Probiotics
Tonics

Water

Does your rabbit drink from a bowl or a sipper-bottle?

Have there been any changes in drinking habits with your rabbit?

Has the drinking increased or decreased as of late? If yes, when did you notice?

The Presenting Health Concern

Has your rabbit had any previous health issues? If yes, please provide details

Please describe your rabbit’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?

Is your rabbit’s nose twitching normally? If no, please specify

Are your rabbit’s droppings normal in appearance and size? If not, please provide details

Have you noticed any coprophagy (rabbit eats droppings)?

Does your rabbit spray urine? (If yes, what color is the urine and has this increased or decreased as of late?)

Does your rabbit thump?

Have you noticed any increases or decreases in thumping?

Any additional comments

Rabbit History Form

Client Details

Rabbit Details

Details of Other Pets

Indoor Rabbit Husbandry

Outdoor Rabbit Husbandry

Food

Water

The Presenting Health Concern

About Us

Regular Clinic Hours

Location

Directions