EXAM Sick Rodent EXAM Sick Rodent This form is designed to help our team gather important information about your pet's current status for your upcoming visit to our Fear Free clinic! Your pet's name:* Your name:* When did the problem start?*What is he/she doing/not doing that has you concerned, and how often? Be as detailed as possible:*Has appetite increased/decreased, or does it remain the same?*Has energy level increased/decreased, or does it remain the same?What kind of pelletes are you feeding your pet? Upload photos of the food below:* Drop files here or Select files Max. file size: 300 MB. How many calories/cups and how frequently is your pet eating?*What type of hay? How much hay per day?*What changes have you noticed in your pet’s personality or behaviors?*Are you feeding your pet any vegetables, fruits or other items? Please list/describe below:Please rate your pet's itchiness score from 1-10, 1 being not itchy at all, 10 being extremely itchy.*12345678910Stool Quality Score*Please rate your pet's stool quality score from 1-5, 1 being profuse diarrhea, 5 being extremely hard.12345Does your pet... (your opinion)* drink too much water drink just the right amount of water not drink enough water Is your pet peeing more than usual?* Yes No Have you noticed any cloudy/bloody urine?* Yes No Describe your pet's kind of cage/housing:*How much time your pet spends outside unattended or roaming freely?*Is your pet currently on flea prevention?* Yes No Please upload pictures, showing labels and expiry dates of your pet’s current flea prevention products: Drop files here or Select files Max. file size: 300 MB. Have you seen any fleas on your pet in the last year?* Yes No Do you have other pets in the house diagnosed with flea infestation?* Yes No Please list any questions/problems/concerns for Dr. Jinni that you would like addressed: Δ