Exotic Animal History Form Bottletree Animal Hospital Exotic Animal History Form Exotic Animal History Form We are so excited to see you and your pet at Bottletree Animal Hospital! We ask that you complete this history form at least 24 hours prior to your appointment time. It may take 10-15 minutes to complete this form, but you may save your response and return to the form later. This will help us provide the most thorough care for your pet. Name of Client * Name of Client First First Last Last Email * Have we seen your pet(s) at Bottletree Animal Hospital before? * Yes No Maybe Home Phone * Cell Phone Address * Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Name of Pet * Species & Breed of Pet * Sex of Pet * Male - Intact/Not Fixed Male - Fixed/Neutered Female - Intact/Not Fixed Female - Fixed/Spayed Unknown Where did you acquire your pet from? (Breeder, friend, adoption, Petsmart, etc.) How long have you owned your pet? * If you are human, leave this field blank. Next
