Name* First Last Pet Name*Where did you get your Pet from?StorePrivate IndividualOtherWhen did you get your Pet?Is your pet kept in a cage, aquarium or free in the house? Please describeIs it inside/outside the house?Is your pet with other pets, if so how many and what kind?Are there any sick pets? Have any pets already died?What signs have you noticed regarding this pet, this incident? Check all that apply Diarrhea blindness vomiting constipation breathing difficulty fainting lethargic eye/nostril/ear/leg bleeding or injury/bitten by another pet skin bleeding itching lameness change in personality change in stool consistency change in appetite excessive water consumption or coughing.Describe any other issue:Has your pet received any treatment for this problem?What's the average temperature of your cage/aquarium?Does your pet ever go outside?What type of bedding do you use for your cage/aquarium?How often do you change out the paper or littler of the cage?How often do you thoroughly clean your pet's cage/aquarium and what do you use to clean it? Please describe:How often do you clean your pet's dishes?How do you provide your pet water and how often is the water changed?Does you pet eat pellets, hay, fruits, or vegetables? Please describe your pet's diet:Do you give any supplements and if so what kind?How much food do you feed your pet?Ho often do you offer fresh food?Has your pet had any recent diet changes?Have there been any recent changes in your pet's cage/environment? Please describePhoneThis field is for validation purposes and should be left unchanged.