Reptile History Form

General Information

Client Name

First Last

Patient Name

First

Date of Birth/Hatch

Species

Gender

Where did you obtain your reptile?

How long have you had your reptile?

Are there other pets in the house? Do any of those pets live in the same cage/enclosure? If so, what species and genders?

Are any of your pets recent additions to the household?

How often does your reptile shed? When was the last time?

Has your reptile been shedding its skin easily, or does it come off in patches?

Environment

What type of enclosure does your reptile live in?

What are the dimensions of the enclosure?

Height x Width x Length

What do you use for the bottom of the enclosure?

Ex; newspaper , wood shavings , sand

What kind of cage furnishings do you have?

Ex; Natural/Fake Branches , Foliage , stones , real plants , etc

How do you heat the enclosure?

Ex; Light bulbs, heat cable, hot rock, etc

What is the temperature of the enclosure during the day?

What is the temperature of the enclosure at night?

How do you measure the temperature?

What is the distance between the hear source and your reptile?

What strength UVB bulb do you have?

How long are the lights on/off during the day?

How long are the lights on/off during the night?

Does your pet get natural sunlight? If yes, how and how long?

Ex; outside, window, etc

What is the humidity of the environment?

How do you control the humidity?

Ex; humidifier, mister, spraying, etc.

How is water offered and filtered? How often do you change the water?

Diet

What do you feed your pet?

Is it live, fresh , frozen, dried?

How often do you feed your pet?

Where do you feed your pet?

Ex; in bowl, water, floor, etc

How often does your pet defecate?

Where does your pet defecate?

Do you use any of the following for your pet?

If yes, how often?

How much water does your pet consume?

Reason for presentation today?

What is the primary complaint or what signs have you noticed?

How long have these problems been present?

What health problems has your pet had previously?

Has your pet received any treatments the last 30 days?

If yes, please give details.

Have you noticed any changes in your pets behavior?

Have any other animals or persons in your household had any illness the last 30 days?

If yes, please describe?

General Information

Environment

Diet

Reason for presentation today?

Casselton Location

Fargo Location

Boarding And Grooming – Fargo

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