AWA Small Animal Client Care Form

This is the Small Animal Client Care Form at Animal Welfare Association.

AWA Small Animal Client Care Form

Date:(Required)

Guardian's Name:(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone:(Required)

Email Address:(Required)

Reason for surrender:(Required)

How many small companion animal(s) are there?(Required)

What species are the small animal(s)?(Required)

For example, rabbit, guinea pig, hamster, rat, gerbil or mouse.

Animal's Name(Required)

Age(Required)

Color(Required)

Sex(Required)

Is your small animal spayed or neutered?(Required)

Do the companion animal(s) have any behavioral issues?(Required)

If yes, then please provide details.

Do the companion animal(s) have any medical issues?(Required)

If yes, then please provide details. Tell us about the symptoms. How long have the small animal(s) been experiencing the issue? When you took the animal(s) to a veterinarian, what diagnosis and treatment did they offer?

From where and when did you get the small animal(s)?(Required)

Do the small animal(s) get time out of their cage?(Required)

If yes, then how many hours per day? Where in the house do they spend this time, e.g. in an exercise pen in the kitchen or in a specified spare room?

Describe the small animals' diet.(Required)

For example, pellets, hay, veggies, etc.

Have the small animal(s) interacted with children?(Required)

If yes, then please provide details. Be specific. Do the small animal(s) live in the same house with the children? What is the frequency of the interactions? What are the children's ages? How exactly do the children interact with the small animal(s)? How do the small animal(s) react to the children?

Have the small animal(s) interacted with dogs?(Required)

If yes, then please provide details. Be specific. Do the small animal(s) live in the same house with the dog(s)? What is the frequency of the interactions? Please detail the other animal(s). What are their names, size, breed, age, altered status (spayed, neutered or intact)? Describe the interactions. For example, if you do not allow the small animal(s) and your dog to interact due to safety concerns, then simply write so. Most small animal guardians do the same.

Have the small animal(s) interacted with cats?(Required)

If yes, then please provide details. Be specific. Do the small animal(s) live in the same house with the cat(s)? What is the frequency of the interactions? Please detail the other animal(s). What are their names, size, breed, age, altered status (spayed, neutered or intact)? Describe the interactions. For example, if you do not allow the small animal(s) and your cat to interact due to safety concerns, then simply write so. Most small animal guardians do the same.

Are the small animal(s) comfortable being handled and/or held?(Required)

Has your small animal recently been sharing a space with a member of the opposite gender? If so, for how long? When did you separate them? This question is to determine if there may be any possibilities of a surprise pregnancy(Required)

Does your small animal have a favorite toy?(Required)

Does your small animal have a favorite treat?(Required)

Additional Notes:

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AWA Small Animal Client Care Form

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