Reptile & Amphibian Health History

Reason for Pet's Visit*

Name*

Species*

Age*

Gender*

Male

Female

Unknown

Reproductive History (history of egg laying, breeding, sterilization surgery)*

How long have you owned this pet?*

Where did you acquire your reptile?*

Breeder

Expo

Pet store

Wild caught

Rescue/Adoption

Other

Shed cycles: most recent shed? Frequency of sheds?*

Past illnesses or significant medical history*

Any changes to appetite, thirst, urination, defecation?*

Changes in behavior?*

Feeding: method of feeding, frequency, last meal?*

Food items: specific types of proteins, specific greens (veggies, fruits, grasses) frequencies of offering each. Any wild animals or insects fed?*

Supplements: calcium +/- Vit D3, multivitamin? Frequency of each.*

Water source: please describe size and location in enclosure:*

Is reptile alone in enclosure or cohabitated?*

Alone

Cohabitated

Heating: what sources of light are used (day/night lights, colors of bulbs) and how long are they on?*

UV Bulb: what type/brand of bulb? UVA and UVB? When was last replaced? Inside or outside enclosure?*

Outdoor time: exposure to direct sunshine and outdoors? How often?*

Enclosure: size of enclosure, what is enclosure made of (glass, plastic, wood, metal, etc.)? What furniture is inside enclosure?*

Humidity: do they measure? What is it? How do they humidify enclosure?*

Temperature: how do you measure temperature? What is temperature at basking spot and coolest spot during the day? What is temperature of warm side and cool side at night?*

Reptile & Amphibian Health History

Reason for Pet's Visit*

Reptile Information

Name*

Species*

Age*

Gender*

Reproductive History (history of egg laying, breeding, sterilization surgery)*

How long have you owned this pet?*

Where did you acquire your reptile?*

Shed cycles: most recent shed? Frequency of sheds?*

Past illnesses or significant medical history*

Any changes to appetite, thirst, urination, defecation?*

Changes in behavior?*

About Their Husbandry

Feeding: method of feeding, frequency, last meal?*

Food items: specific types of proteins, specific greens (veggies, fruits, grasses) frequencies of offering each. Any wild animals or insects fed?*

Supplements: calcium +/- Vit D3, multivitamin? Frequency of each.*

Water source: please describe size and location in enclosure:*

Is reptile alone in enclosure or cohabitated?*

Heating: what sources of light are used (day/night lights, colors of bulbs) and how long are they on?*

UV Bulb: what type/brand of bulb? UVA and UVB? When was last replaced? Inside or outside enclosure?*

Outdoor time: exposure to direct sunshine and outdoors? How often?*

Enclosure: size of enclosure, what is enclosure made of (glass, plastic, wood, metal, etc.)? What furniture is inside enclosure?*

Humidity: do they measure? What is it? How do they humidify enclosure?*

Temperature: how do you measure temperature? What is temperature at basking spot and coolest spot during the day? What is temperature of warm side and cool side at night?*

Where is enclosure located? Near windows? Reptile room? Outdoors?*

Any exposure to other pets/animals in home?*

Frequency of handling?*

Cleaning: how frequent is enclosure cleaned? With what products?*