Email(Required)

Today's Date(Required)

Patient Information

Species(Required)

Date of Birth/Hatch(Required)

Date Acquired(Required)

How big was the reptile when you first acquired it?(Required)

Source (pets tore, breeder, previous owner, etc.)(Required)

Number of previous owners (other than breeder, store)(Required)

What states and countries has your reptile lived in?(Required)

Environment

Where is your reptile kept in the house?(Required)

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Enclosure

Cage type and size(Required)

What is on the bottom of the cage?(Required)

What types of hiding places are provided(Required)

List species of live plants(Required)

Please describe any other furnishings(Required)

How often is the cage cleaned, and what cleaning products are used?(Required)

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Aquatic Species

How often is the cage cleaned, and what cleaning products are used?(Required)

What type of filtration is used?(Required)

Do you use a dechlorinator or any other type of water treatment?(Required)

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Lighting

Estimated hours per week(Required)

Incandescent wattage(s)(Required)

Hours of use per day(Required)

Fluorescent bulb brand(s)(Required)

Hours of use per day(Required)

How often are the fluorescent bulbs changed?(Required)

Temperature

What is the temperature in the warmest part of the cage?

What is the temperature in the coolest part of the cage?

If other, please specify(Required)

If yes, by how much?(Required)

Humidity

If yes, how often?(Required)

Range(Required)

How much time does your pet spend outside of the enclosure?(Required)

Type(Required)

Please explain(Required)

Does your reptile hibernate? Please describe the duration, temperature, and monitoring that you provide during hibernation.(Required)

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List other animal that are kept in the same cage(Required)

Recent acquisitions (new pets within the past 6 months). Please include species, date, and source.(Required)

List any other pets you have(Required)

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List recent changes in the environment, if any(Required)

Diet

What percent of your reptile's diet consists of the following (please describe what the animal actually eats, rather than what is offered:

Vegetables, fruits (list types and percentage of diet)(Required)

Insects, mealworms, etc. (list types and percentage of diet)(Required)

Are they gut-loaded or dusted before feeding to your reptile? Please describe(Required)

Rodents, chicks, etc. (list types and percentage of diet)(Required)

Pellets, commercial diet, or canned food (list types and percentage of diet)(Required)

Other (list types and percentage of diet)(Required)

How often do you feed your reptile?(Required)

Please list any supplements used. How are they given and how often?(Required)

Does your reptile eat anything other than its intended diet (e.g. the cat's food, houseplants)?(Required)

How is water offered (e.g. dish, misting, drip. system)?(Required)

Please list any recent additions/changes in the diet(Required)

When was the last shed? Was it normal?(Required)

Reproductive

How many clutches/litters has this reptile produced (if none, put n/a)?(Required)

How many eggs/babies were laid (if none, put n/a)?(Required)

If yes, please describe(Required)

If no, please describe(Required)

Has your reptile ever been tested or treated for internal or external parasites? Please describe dates and medications used(Required)

Previous conditions, problems, or operations. (listwith date, if known)(Required)

If your reptile is sick, please describe the signs and how long your reptile has been showing these signs(Required)

If yes, please list(Required)

If yes, when?(Required)

Please list tests performed(Required)

Please list medications given(Required)

Is there anything else you would like done today?

Phone

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Reptile History Form