847-367-4070
VHAH@comcast.net

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Book Appointment

Home
About
Resources
Emergencies
Contact
Careers
Online Pharmacy
Book Appointment

Please note: We will be closed on Thursday, November 28th for Thanksgiving!

New clients receive 25% off first exam! Senior citizens receive 10% off exam fee.

Small MammalPatient History

Thank you for choosing Vernon Hills Animal Hospital for your pet’s care. We greatly appreciate it!

VHAH - Small Mammal History Form

Small Mammal Patient History Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s). If this is an emergency, or if your pet needs urgent care, please call us at 847-367-4070 for a faster response.

Name *

First

Last

Email *

Pet's Name *

Species *

Breed *

Color *

Gender *

Age *

Length of Time Owned *

Where Acquired (Breeder, Pet Store, Other, etc.) *

Any other pets in the household? *

Type of Enclosure *

How often is the enclosure cleaned? *

Any other animals in the same enclosure? *

What is on the bottom of the enclosure? *

Newspaper
Carpet
Blanket
Towel
Wire/Mesh
Tile
Wood shavings/chips
Rubber mat
Other

What type of cage furnishings are in the enclosure? *

Litter box
Wheel
Hammock
Fake branches
Toys
Cardboard
Dig Box
Hide box
Natural branches
Foliage
Chew toys
Other

How is water offered? *

Bowl
Bottle

How often is the water changed? *

Does your pet get natural sunlight? *

Yes
No

If 'Yes', outdoors or window? For how long each day? *

Does your pet go outdoors? *

Yes
No

Is he allowed outdoors unsupervised? *

Yes
No

How often do you feed your pet? *

What does your pet eat? *

Timothy pellets
Pellets with seeds / dried fruit
Alfalfa hay
Lab blocks
Fresh greens
Eggs
Raw or cooked meat
Timothy hay
Baby food
Oat / Botanical grass
Fresh veggies
Fresh fruit
Insects
Kibble
Other

How much hay?

Do you measure the pellet amount, and if so, how much?

What type of fresh greens, and how much?

What type of fresh veggies, and how much?

What type of fresh fruit, and how much?

Any treats, and if so, what kind and how much?

Reason for Today's Visit *

Eating? *

Drinking? *

Passing stool? *

Lethargic? *

List all the medications your pet is taking. Write "None" if not on any medication: *

Is there anything else you want us to know?

Heartfelt, Compassionate Care for Your Friends

It is our mission to partner with our clients to nurture and preserve the human-animal bond by providing compassionate, expert, and affordable veterinary care from your pet’s first adventure throughout a long and healthy life.

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Location

1260 Butterfield Rd
Mundelein, IL 60060

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Contact Us

P: 847-367-4070
E: VHAH@comcast.net

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Hours

Mon - Fri: 8 AM – 6 PM
Sat: 8 AM – 1 PM
Sun: Closed

Book Appointment

Have a Question?

Get in touch! Complete the form below, and a member of our team will be in touch with you shortly.
If you’re in need of immediate assistance, please contact us at 847-367-4070.

Name *

First

Last

Email *

Phone

How can we help you? *

Name

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