Home Ever After – Rabbit/ Guinea Pig Assessment Form Thank you for starting the journey of safeguarding your pet’s future welfare. By enrolling your furry friend in the Home Ever Program you will ensure your pet is always looked after come what may. To complete this form you will need to have to hand the following items: Your pet’s microchip number Your vet’s contact details Your pets medication details, if applicable Your pet’s vaccination record Your breeder’s details, if applicable We anticipate the form will take 20 minutes to complete. You can save the form and come back later if necessary too. If you have any questions about the form, please contact the Home Ever After team on 02 9782 4419. 1Personal Information2Vet Details3Rabbit/ Guinea Information4Environment/Lifestyle5Play/Exercise6Family Relationships7Handling8Aggression9Elimination Behaviour10Chewing11Can we? Personal InformationName* First Last Address Address line 1 Address line 2 Town/suburb State Postcode Email* Phone: HomePhone: Mobile*Preferred method of contact Mobile Home Best time to contact Morning Afternoon Evening Second owner's details if any First Last Email PhoneYour HEA Agreement form must be witnessed, please provide their details:* First Last Email* Address* Address line 1 Address line 2 Town/suburb State Postcode Vet DetailsClinic* Name Vet First Last Address* Address line 1 Address line 2 Town/suburb State Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone Rabbit/ Guinea InformationName First Date of birth MM slash DD slash YYYY Breed Weight Sex Colour Distinguishing Features Desexed? Yes No Microchip Number (if applicable) Registered on the Australian Animal Register (AAR)? Medications? Please SpecifyVaccinations Due/WhenWhere did you obtain this animal? Breeder (if applicable) Behaviour of parents or litter mates (if applicable) Environment/LifestyleFor what purpose did you get your pet? Companion Show Breeding Age of pet when obtained FeedingAmount Fed Type of food Frequency of feeding Who does the feeding? When fed and where? Favourite treat Supplements given Does your pet drink from a bowl or bottle? Play/ExerciseFavourite game Type of exercise Amount/Frequency of exercise Amount/Frequency of play Amount/Frequency of touch/handling Favourite enrichment toy Describe where your rabbit/guinea stays at each of the following times:Daytime (owner away) Night time When guests visit How long is your pet alone each day? Reaction prior to approach Left alone outdoors? How often/long? Type of hutch/shelter? Family RelationshipsList family members (include sex and age)List all other pets including breed, age and sex:Describe how your pets get along with each member of the family and each pet:Briefly describe your pet's personality: HandlingHow does your pet react to the following? Nail Trimming Cleaning Ears Checking teeth Giving Medication Grooming/Bathing Being picked- up/ petting Strangers visiting home Other animals on property Do Strays or other pets visit your home frequently? DisciplineDo you use discipline with your pet? If yes, describe AggressionIs your pet aggressive toward people? Yes No List any people your pet is aggressive towards Has your pet ever bitten hard enough to break the skin or cause injury? Yes No Was there an illness or health problem when the aggression started? When your pet is aggressive what is your response? Additional Comments Elimination BehaviourDoes your rabbit use a litter tray? What type? Does your rabbit consistently use a litter tray? Where are the litterboxes kept? How many litter trays are available? How often is the litter tray(s) scooped ? How often is the litter box changed completely? Types of litter Clay Clumping Crystals Other Brand of litter: How long have you used this brand? Where are the litter boxes kept? Are the food/water bowls kept next to/ near litter trays? Are the litter trays located close to any household appliances? ChewingIf your rabbit/ guinea pig has access to the house, does it chew any wires/ other household items? How do you manage any chewing issues? Do you provide chew sticks/blocks? Anything else you would like to share?Phobias/characteristics Can we….Re-home with children? Re-home with male/female? Re-home with a dog? Re-home with a cat? Needs a quiet home? Please attach a photo of your rabbit/ guinea pigMax. file size: 64 MB.Consent* By clicking on the submit button, you declare that you are the legal guardian of the pet and the information you have provided is accurate and true as of today’s date.
