Initial Rabbit Medical History
Technician_____________________________________________ Date _____________________
Client Name _________________________ Patient Name _________________________________
Signalment Plus
- Breed ___________________________________________________________________________
- Birthdate ________________________________________________________________________
- Female/Male
- Neutered Yes/No At what age was the neutering performed? ___________________________
- How long have they owned the rabbit? ______________________________________________
- Where did they obtain him from? ___________________________________________________
- Is he comfortable being handled? – Yes/No
- Any past medical problems? - Yes/No If yes describe __________________________________
_________________________________________________________________________________
- Any other pets at home? - Yes/No If so what are they? _________________________________
- Have any of your pets died recently? – Yes/No If yes what did they die from and when? ___
_________________________________________________________________________________
- Are there any cigarette smokers in the home? – Yes/No
Presenting Complaint/Medical Concerns
- What is the rabbit presenting for today? _____________________________________________
- If ill how long has it been going on? _______________________
- Is the problem progressing, getting better or staying the same?
- Is he eating/drinking like normal? – Yes/No If not describe _____________________________
_________________________________________________________________________________
- Is there any sneezing? – Yes/No If yes describe consistency and frequency. _______________
_________________________________________________________________________________
- Is there persistent or intermittent nasal discharge? – Yes/No If yes describe consistency and frequency. Which nostril left/right/both_____________________________________________
- Has there been any ocular discharge? – Yes/No If yes describe color and frequency. Which eye, left/right/both? ______________________________________________________________
_________________________________________________________________________________
- Has there been any discharge or odor from the ears? – Yes/No If yes describe. Which ear, left/right/both? __________________________________________________________________
_________________________________________________________________________________
- What is the consistency of the droppings? ____________________________________________
- What is the frequency of the droppings? _____________________________________________
- Is he litter box trained? – Yes/No If yes what kind of litter is being used? _________________
_________________________________________________________________________________
- Any other pets or people sick at home? – Yes/No If yes who and what illness_____________
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- Any change in life style? – Yes/No If yes describe _____________________________________
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- Has there been any weight change? Yes/No Increase/Decrease
Diagnostic History (Have these test been completed, date and results)
- Internal Parasite Evaluation – Yes/No
Date ____________________ Results _________________________________________________
- Chemistry and CBC panel – Yes/No
Date ____________________ Results _________________________________________________
Diet
- How is his appetite? _______________________________________________________________
- What brand of pellets and hay are you using? ________________________________________
_________________________________________________________________________________
- List ALL human food fed. _________________________________________________________
_________________________________________________________________________________
- What brand of rabbit treats and how often does he get them? ___________________________
_________________________________________________________________________________
- How much food is offered daily? ___________________________________________________
- How much of the food is consumed? ________________________________________________
- How often is the food changed? ____________________________________________________
- Describe their water consumption. __________________________________________________
- Is the water offered in a bowl or water bottle?
- What type of water is offered? Tap/Bottled/Distilled
- How often is the water changed? ___________________________________________________
- Does he receive any vitamins? – Yes/No
- What brand? _____________________________________________________________________
- How often does he receive them? ___________________________________________________
- Are they given in food/water/by mouth?
- Is he on any supplements? – Yes/No If yes please list name and dose. ____________________
_________________________________________________________________________________
Grooming (Is he in the need of)
- Nail trim – Yes/No
- Teeth trim – Yes/No
- Does he get bathed? – Yes/No If so how often? ________________________________________
What kind of shampoo? ___________________________________________________________
Cage
- Describe the cage in detail; does it include an enclosed hutch, exercise area, littler box, feeding area? _____________________________________________________________________
Size _____________________________________________________________________________
Type of material cage it is made of __________________________________________________
Is there a grate bottom? – Yes/No
- Caged indoor/outdoors.
If outdoors is the cage protected from extreme heat and cold? – Yes/No
Protected against predators and insects? – Yes/No
Protected against environmental toxins? – YES/No
If indoors where is the cage located? _________________________________________________
Is the room temperature well controlled? – Yes/No
- Food bowl material – Ceramic/metal/plastic/glass/other ________________________________
- Toy material – Hardwood/softwood/plastic/rubber/cardboard/rope/other ________________
Quantity _________________________________________________________________________
Does he play with toys? – Yes/No
- What type of substrate is used for cage lining? Newspaper/corncob/sand/gravel/cedar/other _________________________________________________________________________________
- How often is the cage cleaned? _____________________________________________________
Water bowl cleaned? ______________________________________________________________
Food bowl cleaned? _______________________________________________________________
Toys cleaned? ____________________________________________________________________
- Are there any cage mates? - Yes/No If yes, how many, breed and sex? ___________________
- Do they spend any time out of their cage? – Yes/No
If so where are they when out of their cage? _________________________________________
Are they unattended when out of their cage? – Yes/No
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