Reptile History Form

Fill out the fields below and we’ll get back to you.

Patient Name *

Breed

Patient Age

Sex (Male/Female/Unknown)

How did you find out gender? (DNA/Surgical/Physical Traits, other) *

Where Did You Get Your Pet (Pet Store, Breeder, Etc.) *

Reason for Todays Visit? *

Any Health Concerns? *

What type of enclosure does your pet live in? Approximate dimensions? *

What type of bedding do you use? *

Any furnishings, items that are in the enclosure all the time

How often do you clean the enclosure? *

How do you heat the enclosure? (Light bulbs, heat cable, under tank heater, etc) *

What type of bulbs do you use? How often are they changed? *

How do you control humidity? *

Is your pet allowed outdoors? Supervised or unsupervised? *

How is water offered? Bowl or water bottle? How often is it changed? *

List all of the food you offer and how much? : *

Do you use any supplements? How often? : *

Frequency and state of shed? : *

Any other reptiles in the household? : *