Owner Contact Information

Owner name *

First

Last

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

First Visit
Returning client (new pet)
Returning client/patient

Ferret Information

Ferret name *

Age

Birthday (if known)

Color Morph/Variation

Sex *

Male
Female
Unknown

Source of ferret :

Store
Breeder
Adoption/Rescue
Other

Describe *

Environment/Husbandry

Ferret is kept in: *

Size, location and brand of ferret’s enclosure:

Other ferrets in same cage? *

Yes
No

If yes, list names and genders: *

List other ferrets on the premises, past, or present:

Are any of those sick? *

Yes
No

if yes, give details:

Have any passed away? *

Yes
No

if yes, give details:

List other pets in the home or yard:

List toys/hideouts/hammocks available to the ferret including materials:

What do you use on the bottom of the cage?

Eexplain

How often is the bedding/lining changed and or washed?

Frequency of cage cleaning and products used:

Method and frequency of cleaning/changing food and water source:

Sleeping habits: *

Hours of darkness
Covered
Uncovered

Hours of darkness: *

What is the current diet (Include brands of products):

Dry Food:

Wet Food:

Other (describe)

Volume of food offered:

Dry Food:

Wet Food:

Other (describe):

Amount consumed daily:

Dry Food:

Wet Food:

Other (describe):

How often is food replaced?

Do you give your ferret baths?

How often?

What product do you use for bath?

Medical History

Previous illnesses or injuries:

Previous medications:

Any current medications: *

Yes
No

If yes, describe:

Vaccination history: Rabies Vaccinated? *

Yes
No

If yes, date last given?

History of vaccine reactions: *

Yes
No

If yes, to what? *

History of allergies: *

Yes
No

If yes, to what? *

Nail trimming at home? *

Yes
No

Date of last examination: *

Any previous medical records? *

Reproductive History

Has the ferret been spayed or neutered? *

Yes
No

Has it been descented? *

Yes
No

For females, has the ferret ever had a litter of young? *

Yes
No

If yes, when? *

Behavioral History

Any behavioral issues:

Yes
No

Describe *

How long has it been an issue?

Any previous or current treatments for behavioral issues:

Does your ferret use a litter box?

Have you ever had difficulty with litter box usage?

Yes
No

Current Health Status

Reason for visit: *

Wellness exam (New pet)
Wellness Exam (Return/Annual visit)
Illness/Injury Exam

If ill, describe signs and concerns: *

How long have problems been occurring? *

Has this Ferret been seen for this problem before by a veterinarian?

Yes (At AEAC)
Yes (at another practice)
No

If seen at another practice, please name: *

Have you tried treatments prescribed by a veterinarian?

Yes
No

If yes, what? *

Was it helpful?

Yes
No

Have you tried any treatments at home?

Yes
No

If yes, what? *

Was it helpful?

Yes
No

Mark any of the following symptoms seen

Characteristics of droppings:

Formed
Diarrhea
Blood
Increased urine

Stool color

Other changes/abnormalities:

Any other concerns:

Ferret History Form