 info@exoticpetclinic.com  831-440-8590.. . . .

Home
Current Clients
New Clients
Referrals
About Us
Services
Forms
Resources

Contact Book Appointment

Please note: We will be closed on Monday, September 7 for Labor Day.

We have Rabbit Hemorrhagic Disease vaccines in stock!

History Form

This history form is for hamsters, rats, and mice.

Hamster, Rat, & Mouse History Form

Please fill out the following form as thoroughly as possible. Please note: All * fields are required.

Owner's Name *

First

Last

Phone *

Email *

Date *

Patient Information

Pet's Name *

Species: *

Breed: *

Major Colors

Gender *

Male
Female
Unknown

Spayed/Neutered *

Yes
No
Unknown

Date of Birth/Age *

How long have you had this pet? *

Where did you get your pet? *

Pet Store
Breeder
Friend
Shelter
Other

If other, please specify. *

Environment

Describe your pet's enclosure - flooring, size, and materials. *

What bedding is used on the floor of the cage? *

Diet

Does your pet eat pellets or blocks? *

Yes
No

Does your pet eat a seed mix? *

Yes
No

What brand?

Does your pet eat fresh vegetables or fruit? *

Yes
No

Does your pet get any treats? *

Yes
No

If yes, what kinds? *

Previous Veterinary Care

Has your pet received care at another veterinary clinic? If so, please tell us the name of the clinic.

Has your pet had previous medical problems? *

Today's Visit

What is the reason for your visit? *

Schedule a Visit

We're excited to meet you!

Book Appointment

Questions?

Contact us with the information below or fill out our online form.



Contact

E: info@exoticpetclinic.com
P: 831-440-8590

}

Hours

Mon - Fri: 8:30 am to 6:00 pm
Sat - Sun: Closed



Location

5400 Scotts Valley Drive, Suite B
Scotts Valley, CA 95066

Name *

First

Last

Email *

Phone *

Phone Type *

Mobile
Landline

How can we help you? *

Custom Captcha *

What is 7+1?

Message

© 2026 Exotic Pet Clinic of Santa Cruz | Powered by PetDesk

Translate »