Rabbit Pre-Visit Form - Exotic Vet Care

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This field is for validation purposes and should be left unchanged.

(This form helps us to get a better understanding of how your rabbit is cared for at home and must be filled PRIOR TO the appointment)

Name(Required)

Prefix First Last Suffix

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

What is the name of your rabbit?(Required)

What breed is your rabbit?(Required)

What is the birth date or estimated age of your rabbit?(Required)

Gender?(Required)

How long have you had your rabbit and where did you get it from?(Required)

Prior vet/clinic information(Required)

What are the symptoms of concern for your pet and when did you first notice?(Required)

Have you done any home remedies or treatments for your concerns? If so, please list what and how often you've done this.(Required)

Has your rabbit had any previous medical concerns?(Required)

Is your rabbit on any current medications? If so please list what medications they are on.(Required)

Is your rabbit microchipped?(Required)

Yes

What do you feed your rabbit/s? Please list daily amounts of each food. (Very important!)(Required)

Is your rabbit vaccinated? If so please list when the last vaccination was given (rough dates are okay if you aren't sure).(Required)

Where does your rabbit live, indoors or outdoors?(Required)

Do any other animals live with your rabbit/s? ie guinea pigs etc(Required)

Yes

Lastly, how did you first hear about Exotic Vet Care?(Required)

Google (or other search engine)

Social media (Facebook, Instagram, YouTube etc)

Recommended by a friend or colleague

I saw the clinic from the street

Other

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