InstagramThis field is for validation purposes and should be left unchanged.(This form helps us to get a better understanding of how your guinea pig 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email(Required) What is your guinea pig’s name?(Required)What type/breed of guinea pig do you have?(Required)What is the birth date or estimated age of your guinea pig?(Required)Gender?(Required) Male Male/Castrated Female Female/Spayed UnsurePrior 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 guinea pig had any previous medical concerns?(Required) Yes NoIs your guinea pig on any current medications? If so please list what medications they are on.(Required)Is your guinea pig on any vitamin C supplementation? If so in what form, how much and how often?(Required)How long have you had your guinea pig and where did you get it from?(Required)What do you feed your guinea pig/s? Please include the daily amounts of each item that are offered. (Very important!)(Required)Where does your guinea pig (or guinea pigs) live?(Required)What is the size of the enclosure?(Required)Do any other animals live with your guinea pigs/s? ie rabbits etc(Required) Yes NoLastly, 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 OtherΔ
