Rabbit Husbandry Form
All information provided is strictly confidential. Please fill questionnaire to the best of
your knowledge.
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Owner's Full name? *
Date *
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/
DD
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Name of Rabbit *
Breed? *
Gender? *
Required
Age? *
Length of time owned? *
Where did you acquire your rabbit? *
How often is rabbit handled? *
Character of feces? Any changes? Attach picture if possible.
Housed indoors/ outdoors *
Is rabbit allowed to free roam in the house? *
Is your rabbit kept in an enclosure? If so, where is it located? *
Type of enclosure? Attach picture if possible. *
Size of enclosure? *
Is there galvanized metal in your enclosure?
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What type of bedding is used in enclosure? *
What time of bottom/ flooring on the enclosure? *
How often is cage cleaned? *
What type of disinfectant is used when cleaning enclosure? *
Type of food offered ~ please list all *
Amount fed/ frequency?
Supplements offered and frequency? (i.e. fresh grass, carrots, lettuce, vitamins, etc.) Attach pictures of packaged treats/ supplements if possible.
Water source? *
How is the water offered? *
How often is the water changed?
Any other pets? If yes, please specify. *
If other pets, do they interact with rabbit?
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If you own other rabbits, are they housed together or singly?
If not housed together, where is/are the other rabbit(s) located?
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Any new additions to your pet population? If yes, please specify.
Any previous medical concerns or treatments? Please transfer any previous medical records to staff@crossroadsahc.com
Current presenting problem(s)? how can we help you?
Duration of complaint? Did symptoms develop suddenly or over time?
Any other questions or concerns?
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