Mammal History Form

Name: Greentree Animal Clinic
Address: 2080 Greentree Rd, Pittsburgh, PA, 15220, United States
Telephone: 412-276-3311
Price range: $

Thank you for choosing Greentree Animal Clinic.

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Mammal History Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 412-276-3311 for a faster response.

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Mammal Name

Name *

First

Last

Email *

Common or Scientific Species Name *

Date of Birth *

Age *

Sex *

Female
Male
Unknown

Sex Determined by *

DNA
Endoscopy
Visual
Other

If other, please specify *

Neutered/Spayed *

Origin *

Captive Bred
Wild Caught Import
Unknown

How long have you had this animal? *

Where did you obtain this animal? *

Is your animal vaccinated? *

List vaccines and dates given

If primate, has your animal been tuberculosis (TB) tested? *

Is yes, when?

If applicable, do you have a license (DNR/USDA) to own this animal? *

(Please bring your license with you as a photocopy will be required for the medical record)

Do you have any other pets in your household? *

If yes, list number and species

When was the last animal added to your household? *

Has your pet had contact with any other animal in the last 30 days? *

Cage Environment

Where is the cage located? *

Inside
Outside

Details

What percentage of time does you animal spend in the cage? *

Is your animal supervised when out of the cage? *

What is the cage made of? *

What are the dimension of the cage? *

Has there been any changes in the environment in the last 3 months? *

Details

What decor and furnishings are present?

Is there ventilation (grills or mesh)? *

Details

What bedding do you use?

Is your animal litter trained? *

Is your animal supervised when outside of its cage? *

Do you provide any bathing facilities *

Details

What is your animal's day and night cycle?

Are there any smokers in the house? *

Do you use aerosolized substances? *

How often is the cage cleaned? *

What cleaning/disinfectant agent are used? *

Diet

How often do you feed your animal?

Indicate which foods are eaten, and in what amount *

Pellets
Vegtables
Hay
Fruits
Treats
Meat or meat products

Brand or type *

Amount *

Nutritional Supplements? *

If yes, how much and how often? *

What type of water supply do you provide? *

Tap Water
Bottled Water
Other

If other, please specify *

How is water provided? *

Bowl
Dripper System
Spray

How often? *

How often is the water changed? *

Do you use any water supplements? *

Details

Have you noticed any changes in eating/drinking behavior? Please provide details.

Have you noticed any changes in droppings? (Fecal Material, Urine, Urates) Please provide details.

REASON FOR PRESENTATION TODAY

What is the primary complaint or what signs you have noticed? *

Has this animal had previous health problems *

Details

Has any other animals or persons in the household had any illness within the last 30 days? *

Has your animal recieved any medication in the last 3 months (i.e. heartworm medication, dewormer, flea treatment) *

We're Excited to meet you!

We strive to deliver the best veterinary care for your pet.

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Questions?

Feel free to contact us at either of our convenient locations.

Our Main Location

Pittsburgh

2080 Greentree Rd
Pittsburgh, PA, 15220
Get Directions

P: 412-276-3311 | F: 412-276-4097
E: greentreevet@greentreevet.com

Clinic Hours

Monday & Tuesday: 8 am - 8 pm
Wednesday: 8 am - 4 pm
Thursday: 8 am - 8 pm
Friday: 8 am - 4 pm
Saturday: 8 am - 1 pm
(open EVERY OTHER Saturday starting Sept 2nd)
Please call to confirm hours

Our Second Location

South Fayette

1460 Hastings Crescent
Bridgeville, PA 15017
Get Directions

P: 412-276-3311
E: greentreevet@greentreevet.com

Clinic Hours

Monday - Friday: 8 am - 4 pm
Saturday: 8 am - 1 pm
(closed EVERY OTHER Saturday starting Sept 2nd)
Please call to confirm hours

Name *

First

Last

Email *

Phone

Please select the desired clinic location: *

How can we help you? *

Name