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Reptile History Form
Reptile History Form
Client Name
*
First
Last
Animal Name:
Date
MM slash DD slash YYYY
Species:
Age:
Sex:
Pet Animal/Breeder
Background Information:
Length of time owned:
Where acquired?
Breeder
Pet Store
Other
Wild-caught or Captive Bred?
Deparasitized?
If yes, with what?
How often is animal handled?
Daily
Occasionally
Never
Animal ever taken outside?
No
Yes
If yes, for how long?
When was last shed?
Any trouble shedding?
No
Yes
If yes, specify
Fecal Consistency
Husbandry:
Type of enclosure:
Size of enclosure:
Where is cage located?
Cage furniture:
Cage substrate:
Frequency of cage cleaning?
Type of disinfectant used to clean cage?
Cage Environment:
Light cycle:
Type of lighting (Fuorescent, UVB):
Heat source:
Humidity level:
Temperature within cage:
Minimum
Maximum
Basking area
Heat measurement device:
Last date UVB bulb changed:
Nutrition:
Types of food offered:
Amount fed & frequency:
When last fed
Water Source(s)
Any calcium or vitamin supplementation?
Any other pets?
No
Yes
If yes, specify
Any other reptiles?
No
Yes
If yes, specify
Past Medical History/Problems:
Current Presenting Problem:
Duration of Complaint:
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Call us or schedule an appointment online.
2
Meet with a doctor for an initial exam.
3
Put a plan together for your pet.
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