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207-825-8989

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Prescription Refill

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Home
About Us
- Meet Our Staff
- Photo Gallery
Services
Exotics
- Exotic Veterinary Care
Resources
- Payment Options
Kindred Community
- Community Photos
- Pet Adoption Application
Pharmacy
- Prescription Refill Request Form
Join Our Team!
New Patient Forms
Contact
Book Appointment

We are currently accepting new clients!

Hedgehog History Form

Please fill out the following questions as accurately as possible.

Hedgehog History Form

Information Spayed of

Owner Name *

First

Last

Email *

Phone Number

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Patient Information

Name *

First

Last

Sex *

Spayed or Neutered *

Yes
No

Age

Length of time owned

Where were they acquired

Any other hedgehogs in the house? *

Yes
No

Are they housed together? *

Yes
No

Date of most recent new hedgehog brought into the house: *

Any other hedgehogs showing signs of illness? *

Yes
No

Other pets in the house (please list)

Environment

Please describe cage

Size of cage

Bedding used in the cage

Any cage furniture?

Toys?

Wheel? *

Yes
No
Wire bottomed

Cage temperature

Additional heat source in winter (if present/needed)

Nutrition

What is the water source

How frequently is it changed

What is their current diet including brand? *

What volume of food are they fed?

Any treats offered, what type?

Medical History

Any previous illnesses or injuries:

Any current medications or supplements

Any flea or mite treatment (brand)

Date of last examination *

Name and location of last veterinary hospital

Please send records from previous vet! *

Drag & Drop Files, Choose Files to Upload

Today’s Visit

Reason for the visit *

Wellness exam
Sick exam

If sick, what are the symptoms: *

How long have they been showing symptoms

Have you tried any treatments?

I understand that a non-refundable deposit of $113.00 is required for all initial new client visits. *

I have read and understand.

Any other concerns?

Questions?

Get in touch! We look forward to hearing from you.

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Location

857 River Road
Orrington, ME 04474

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Contact Information

Phone: 207-825-8989
Fax: 207-825-8901
Email: reception@kindredvet.com

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Hours

Monday-Friday: 8:00  am–5:30 pm
Saturday: Closed
Sunday: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

Comment

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