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Rabbit Initial Medical History Checklist

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_____________
    _________________________________________________________________________________
  • Any change in life style? – Yes/No If yes describe _____________________________________
    _________________________________________________________________________________
  • 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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