Rabbit Assessment Form

First & last name(required)

Email(required)

Phone number(required)

Address(required)

Rabbits name(required)

Age(required)

Breed(required)

Sex(required)

Male

Female

Neutered male

Spayed female

When and at what age did you acquire your rabbit?(required)

Where did you get your rabbit?(required)

What other pets live with your rabbit?(required)

What other humans live with your rabbit?(required)

Current veterinarian(required)

Last veterinary exam (YYYY-MM-DD)(required)

Do you consent that I contact your veterinarian for medical records?(required)

Yes

Medical concerns(required)

Current medications & supplements(required)

Diet(required)

How is your rabbit at the veterinary hospital?(required)

Does your rabbit need assistance with husbandry or foundation behaviours?(required)

Nail trimming Body handling & restraint Medication administration Veterinary exam Getting into a carrier Grooming Stationing None at this time

Other

Does your rabbit eliminate outside the box? If yes, is it urine and feces? How often?

How many litterboxes do you have?

How big are the litterboxes?

Where are the litterboxes located?

Behavioural concerns(required)

What do you feel is the function of the behaviour(s) mentioned above?(required)

What have you tried so far?(required)

Did it make the behaviour better or worse?(required)

Has your rabbit ever shown aggressive behaviour? If yes describe the events.(required)

How long is your rabbit home alone for?(required)

Anything else you’d like me to know?

Rebecca Melanson – Around the Flock

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