Online Forms

Small Mammal History Form

Thank you for choosing Creekside Veterinary Hospital! Please fill out this form as accurately as possible if you would like to discuss weight loss at your appointment, or if you’ve been asked to by a CVH employee..

Name *

First

Last

Phone *

Email *

Pet Information

Pet's Name:

Common or scientific species name: *

Date of birth:

Age:

Sex

Male
Male Neutered
Female
Female Spayed
Unknown

How long have you had this animal?

From where did you obtain this animal?

Is your animal vaccinated?

List vaccines and dates given:

If a primate, has your animal been tuberculosis (TB) tested?

If yes, when?

If applicable, do you have a license (DNR/USDA) to own this animal?

**Please bring your license with you as a photocopy will be required for the medical record.**

Do you have any other pets in the household?

If so, list the number & species:

When was the last animal added to your household?

Has your pet had contact with any other animals in the last 30 days?

Cage Enviornment

Where is the cage located?

Inside
Outside

Provide details:

What percentage of time does your animal spend in the cage?

Is your animal supervised when out of the cage?

What is the cage made of?

What are the dimensions of the cage?

Have there been any changes in the environment in the last 3 months?

Please give details:

What decor and furnishings are present?

Is there ventilation (grills or mesh)?

Please give size and details:

What beddings do you use? Please give details.

Is your animal litter trained?

Do you provide any bathing facilities? *

Please give details: *

What is your animal's day and night cycle? *

Are there any smokers in the house? *

Do you aerosolized substances?

How often is the cage cleaned? *

What cleaning/disinfection agents are used? *

How often do you feed your animal?

Indicate which foods are eaten, and in what amounts (by weight, or approx. volume).

Pellets
Vegetables
Hay
Fruits
Treats
Meat or meat products
Other

Brand/Amount?

Type/Amount?

Do you use any nutritional supplements?

If yes what, how much, and how ofter:

What water supply do you provide? *

Tap water
Bottled water
Rain/river water

How is the water provided? *

Bowl
Dripper system

How often?

How often is the water changed? *

Do you use any water supplements? *

Please give details:

Have you noticed any changes in feeding or drinking behavior? *

Please give details:

Have you noticed any changes in the droppings?

Section Divider

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

Has this animal have previous health problems?

Please give details:

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

Has your animals received any medications in the last 3 months (i.e. heartworm, dewormer, flea treatments)

Ready to visit?

we know that pets are family.

We believe you deserve compassion, integrity, and collaboration with each step of your pet’s life. Come meet us! We can’t wait to help you and your pet.

Book An Appointment

Have a question?

Contact us

Complete our online form, and we will be in touch with you shortly.



Address

2987 Hunting Dr. NW, Cleveland, TN 37312



Contact

E: [email protected]
P: 423-709-7979
T: 423-799-2937



Hours

Mon: 8 am – 6 pm
Tue: 8 am – 6 pm
Wed: 8 am – 1 pm
Thu: 8 am – 6 pm
Fri: 8 am- 6 pm

** Our hours are set to expand! As soon as we can grow to add more employees and doctors, we will be offering even more hours for your convenience and for your pet’s urgent needs! **

Name *

First

Last

Email *

Phone

How can we help you? *

Website

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Our appointment booking system is coming soon!