Date

Your Name

Your Email

Patient information

Species

Gender

Male

Female

Unknown

Date of birth/hatch

How big was the reptile when you first acquired it?

Source (pet store, breeder, previous owner)

Please check one

Captive bred

Wild caught

Number of previous owners (other than breeder, store)

What states and countries has your reptile lived in?

Environment

Where is this reptile kept in the house?

Enclosure Cage: type and size:

What is on the bottom of the cage?

List species of live plants

Is there a soaking/swimming tub?

Please describe any other furnishings

How often is the cage cleaned & what cleaning products are used?

Aquatic Species

How often is the water changed?

What type of filtration is used?

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

Lighting

Does your reptile receive sunlight?

Yes

Estimated hours per week

Does the sunlight pass through glass or plastic before reaching the reptile?

Yes

Artificial lighting

incandescent (screw-in bulbs)

fluorescent (tube bulbs)

Wattage(s)/hours per day/brand(s)/how often are the fluorescent bulbs changed?

Temperature

Do you have a thermometer(s) in the cage?

Yes

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

In the coolest part?

What device(s) are used to maintain the temperature?

hot rock

heat pad

warm room

heat light

ceramic heater

aquarium heater

other

Is there a thermostat?

Yes

Is the temperature decreased at night?

Yes

Is there a thermostat?

Yes

Humidity

Is the cage misted?

Yes

How often?

Is the humidity measured?

Yes

Range

How much time does your reptile spend outside of the enclosure?

Is your reptile supervised when it is out?

Always

Sometimes

Is supplemental heating provided outside the cage?

Yes

Type

Have you ever noticed your reptile eat any household objects?

Is the reptile ever taken outside?

Yes

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

Do you gave other pets?

Yes

If yes, List other animals that are kept in the same cage

Recent acquisitions (new pets within the past 6 months), species, date, source

List any other pets you have

Are any of your other pets ill?

Yes

If yes please list

List recent changes in the environment, if any

Diet

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

Vegetables, Fruits - % and list types

Insects, mealworms, etc. % and list types

Are they "gut loaded" or dusted before feeding to your reptile? Describe

Rodents, check etc % list types & source

Are they fed

live

killed

both

Pellets, commercial diet or canned food - % list types

Other - %, describe

How often do you feed your reptile?

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

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

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

Please list any recent additions/changes in the diet

When was the last shed?

Was it normal?

Yes

Reproductive

Do you plan on breeding this animal?

Yes

Possibly

How many clutches/litters has this reptile produced?

When was the most recent clutch/litter?

How many eggs/babies were laid?

Has your reptile ever had difficulty laying?

Yes

Describe

Were the offspring healthy?

Yes

If not please describe

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

Previous Conditions, Problems, or operations (list with date, if known)

Is your reptile here for a

wellness check up

or is it sick

If your reptile is sick please describe the symptoms and how long your reptile has been showing signs

Is your reptile's general activity level:

Normal

Decreased

Increased

Have you noticed any of the following?

Weight loss

Weight gain

Discharge from the eyes or nose

Increased breathing rate or effort

A change in the droppings

Abnormal skin color or shedding

Parasites on the skin or in the feces

Weakness

Have you used any medications from a pet store?

Has your reptile been seen by another veterinarian for any of the current problems?

Yes

If yes, when?

Please list tests performed

Please list medications given

Is there anything else? Nail trim, I have questions about, Other

***Did you know that most reptiles carry Salmonella that can infect humans? *** Please read and keep the attached handout on Salmonella

Signature

Please sign here that you have received this handout

Reptile

Get In Touch

How Are We Doing?