Client Details

Name

First Last

Address

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

Phone Number

Email Address

Rat Details

Name

Age (date of birth)

Sex

Is your rat spayed or neutered?

Date acquired

Source (pet shop, friend, breeder, etc)

Details of Other Pets

Do you have any other rats? 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 rat kept in a cage indoors? If yes, please provide approximate dimensions

Please describe the bedding and litter used in the cage

Where does your rat urinate and defecate?

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

Food

Please describe your rat'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 rat?

Vitamins
Minerals
Medicines
Probiotics
Tonics

Water

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

Have there been any changes in the drinking habits of your rat?

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

The Presenting Health Concern

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

Please describe your rat’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 rat’s droppings normal in appearance and size? If not, please provide details

Have you noticed any coprophagy (rat eats droppings)?

Any additional comments

Rat History Form

Client Details

Rat Details

Details of Other Pets

Husbandry

Food

Water

The Presenting Health Concern

About Us

Regular Clinic Hours

Location

Directions