ZOO/AQUARIUM GENERAL HEALTH and DIET HISTORY FORM: INDIVIDUAL

Best Contact Information

Animal Information

ID Number
House Name
Age/ DOB
Animal Information
Sex (M/F)
Spayed/Neutered (Y/N)
Chemical Birth Control (Y/N)
Previous 3 body weights measured with corresponding dates, if available:
*Note: If a weight record is available, please attach it in an email to the team at info@ardentevetnutrition.com.
Body Weight (kg)
Date Body Weight Obtained
 
Reproductively active, if intact and housed with opposite sex conspecific?:
Is this animal housed with any other animals?
Is this animal being treated for any current and/or historical condition(s) or disease(s)?
If yes, please list diagnosed condition/disease, approximate date of diagnosis, medications.
Condition/Disease
Date Diagnosed
Medication Name, Dose, Route, Frequency
 

Diet and Enrichment Information

Feeding Strategy


Instructions for the following questions:

  • For each food item, the "Offered Amount (by weight)" must be a measured amount using a scale with units in grams. Input the TOTAL weight (grams) of the ingredient fed daily.
  • For each food item, the "Consumed Amount (estimated %)" should describe the amount of offered food item the animal consumed. This can be represented as an estimated % consumed, out of 100% (or complete consumption).

Possible scenarios to troubleshoot:

  • Unlabeled cup or scoop: First measure the amount held in that cup/scoop - for example, “½ scoop” may actually represent a true 1 cup, as measured. Then weigh the volume of diet item held within that container.
  • Abstract unit of measure (e.g. “one handful”), take one handful of the item and obtain the gram weight of that handful 5 days in a row. If different individuals are doing the feeding, make sure that each individual’s handful is represented. Then calculate the average weight (grams) per handful by summing the gram weights from each of the 5 days, and dividing by 5. Provide that average weight as the “Amount” below.
  • Hay/browse: For each type of hay/browse item, use either hook scale or flat platform scale and obtain average weight over 5 days.
Commercial Feeds
Describe all brands, product names, amounts, and frequency for ALL commercial foods offered as a part of regular diet.
Manufacturer
Product Name
Form
Offered Amount (by weight, grams)
Frequency
Consumed Amount (estimated %)
 
Hay/Browse
List types of hay and browse offered
Producer/Distributor
State
Type of Hay/Browse
Offered Amount (by weight, grams)
Frequency per day
Consumed Amount (estimated %)
Days per week
 
Whole Food Items
Please provide information on how food items are prepared (*whole vs. chopped, cooked vs. raw, live vs. frozen/thawed, etc.)
Food item
Preparation*
Offered Amount (by weight, grams)
Frequency
Consumed Amount (estimated %)
Months offered
 
Other Food Items
List other food items offered for enrichment purposes (e.g., training, enrichment, educational programs, etc.).
Food item
Preparation
Offered Amount (by weight, grams)
Freq per day
Consumed Amount (estimated %)
Months offered
 
In the last 5 years, have you ever had a nutrient analysis performed by a laboratory on either the whole diet and/or any individual food items (e.g. hay, browse, leafy greens, etc.)?
Have you made any changes to the diet offered in the last 4 weeks?:

Water and Supplementation Information

How often is water changed?
Are any additives put into the water (vitamins, flavors, etc.)?
Are any dietary supplements (vitamins, fatty acids, oils, etc.) given?
If yes, please describe brand/type, quantity, frequency.
Manufacturer
Type
Dose
Frequency
 
Are salt or trace mineral blocks provided?