Guinea Pig Pre-visit Questionnaire Guinea Pig Questionnaire (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 * Name First First Last Last Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Email * What is your guinea pig’s name? * What type/breed of guinea pig do you have? * What is the birth date or estimated age of your guinea pig? * Gender? * Male Male/Castrated Female Female/Spayed Unsure Prior vet/clinic information * What are the symptoms of concern for your pet and when did you first notice? * Have you done any home remedies or treatments for your concerns? If so, please list what and how often you've done this. * Has your guinea pig had any previous medical concerns? * Yes No Is your guinea pig on any current medications? If so please list what medications they are on. * Is your guinea pig on any vitamin C supplementation? If so in what form, how much and how often? * How long have you had your guinea pig and where did you get it from? * What do you feed your guinea pig/s? Please include the daily amounts of each item that are offered. (Very important!) * Where does your guinea pig (or guinea pigs) live? * What is the size of the enclosure? * Do any other animals live with your guinea pigs/s? ie rabbits etc * Yes No Lastly, how did you first hear about Exotic Vet Care? * Google (or other search engine) Social media (Facebook, Instagram, YouTube etc) Recommended by a friend or colleague I saw the clinic from the street OtherOther Captcha Submit If you are human, leave this field blank.
