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Home » Medical Forms » Sugar Glider Husbandry Questionnaire

Sugar Glider Husbandry Questionnaire

Client Name

Patient Name

Species (Select One)

Known/Estimated Age

Sex

Male

Female

Unknown

Reproductive Status (Select One)

Intact

Spayed

Neutered

Current History

Why are we here today

Duration of Problem

Any treatments/medications give

Coughing?

Yes

No

Sneezing?

Yes

No

Nasal Discharge?

Yes

No

Vomiting?

Yes

No

Diarrhea/Change in Feces?

Yes

No

Changes in Urination?

Yes

No

Twitching?

Yes

No

Itchiness/Scratching?

Yes

No

Bulging Eyes?

Yes

No

Changes in Appetite?

Yes

No

Changes in Activity?

Yes

No

Changes in Movement?

Yes

No

Past History

Where did you acquire?

How long in your care?

Prior medical concerns or diagnoses

Have you been to a vet before this?

Yes

No

If Yes, Where?

Treatments?

Husbandry

Enclosure

Enclosure size and type

Substrate type

How often is substrate cleaned

Enclosure features (hides, furniture, toys, etc) (brands, materials, etc)

Temperature

Is temperature measured?

Yes

No

If Yes, what is the average:

Day

Night

Heat sources available

Location(s) in enclosure

Diet

Fed commercial diet?

Yes

No

If yes, what brand?

How much fed daily

Fed insects?

Yes

No

If yes, what types?

Frequency/Amount

Are insects gut-loaded?

Yes

No

If Yes, with what?

What treats are fed?

Frequency

Any supplements/vitamins?

Frequency

Any recent changes in diet?

Water

Water source available

Bowl

Bottle

How often is it refilled?

How often is it cleaned?

Daily Life

How often are they handled?

Do they interact with any other animals?

Do they go outside?

Picture of your enclosures

Max. file size: 50 MB.

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(847) 885-3344

51 E Remington Rd.,
Schaumburg, IL 60173

make an appointment

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Monday

Open 24 Hours

Tuesday

Open 24 Hours

Wednesday

Open 24 Hours

Thursday

Open 24 Hours

Friday

Open 24 Hours

Saturday

Open 24 Hours

Sunday

Open 24 Hours

Our hospital is open for walk-in care 24/7, however we have appointments for general practice wellness visits Monday - Friday 8am-7pm and Saturdays from 8am - 3pm. Walk-in emergencies will be prioritized and pets with non-urgent needs will be seen as soon as possible.

(847) 885-3344

51 E Remington Rd.,
Schaumburg, IL 60173

make an appointment

Home
Our Hospital
Services
Lodge & Grooming
Resources
Online Pharmacy
Contact Us
- Email Golf Rose
- My Pet is Lost

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