Pre-appointment (exotics) Pre-appointment (exotics) Exotics Pre Appointment Form Please have this form completed before coming to the hospital to help the doctor and technician understand your pet's health and address any concerns promptly. You can email it back before your appointment for the doctor to review in advance. Appointment: Please arrive 10 mins before your appointment time unless the pre-appointment form has been completed and emailed to our office. Name * Name First First Last Last Pet's Name * Phone * Email * General History How long have you had this pet? Is this a pet or breeding animal? Pet Breeding Both How old are they? How big are they? Where did they come from? Store or breeder Wild caught or captive bred How often are they handled? Do they usually cope well with handling? Do you take your reptile outside? Yes No If yes, how often and how long? Have they ever hibernated before? Yes No If yes, how many times and how long? Housing What are they housed in? Size (gallons/dimensions)? What substrate/bedding is used? What other accessories are in the enclosure? How often is the enclosure cleaned? What do you clean it with? Where in the home is the enclosure? Heating What temperature (gradient) is it kept at? Please answer in degrees Daytime Cold Daytime Hot Basking Overnight Cold Overnight Hot What heat sources do they use? (can click more than one) Heat mat Ceramic heat emitter Flood light / incandescent Aquarium water heater None OtherOther Where are the heat sources situated? How far from the pet is the heat source? Can they come into direct contact with the light? How do they measure the temperature? (can click more than one) Temperature gun Thermometer mounted in enclosure Thermostat None OtherOther UV Is there UV light? Yes No What kind of light is it? (brand, shape/length/size; is it a linear or coiled bulb that screws in?) Is the light full spectrum/does it have UVB? Yes No When did you last change the UV light? How often is the light changed? How far up is the UV light from the basking area? Is it placed on top of a screen? How long are the lights on for? Aquatic Species What filtration is used? How often is it cleaned and changed? What is used to clean When was the last full water change? Has the water quality been tested recently? Humidity How often do they get bathed or misted? Is there a humid hide in the enclosure? Yes No What is the humidity in the enclosure? What is it measured with? Other Animals Is this pet housed with other animals? Yes No If yes, please write what and how many Is there any other reptiles in the house? Yes No If yes, how many Diet What are they fed and how much? For insect eater; are the insects gut loaded before feeding? Yes No If yes, what is used to gut load? Do you use calcium dust? Yes No If yes, how much and how often? Does it contain vit D and multivitamin? How often are they fed? Do they generally have a good appetite? If fed any live prey (including insects), is any uneaten prey removed after feeding? Yes No Are they ever hand fed? Yes No If yes, how often? Do they eat on their own without hand feeding? Yes No What type of supplements are given? (brand. ingredients) How often are the supplements given? What is the water source? Bowl Dripper system Spray OtherOther What type of water is used? Tap Bottled Distilled Deionized OtherOther How often is the water changed? Is there anything added to the water? Medical History Upload Pet Records Drop a file here or click to upload Choose File Maximum file size: 52.43MB Still eating and drinking? Yes No Regurgitation or vomiting? Yes No Last stools and urates? Normal color and consistency? Do they pass urates normally? Yes No What are the color and consistency of the urates/urine? Is there ever more urates than feces? Yes No Any recent changes in the home? Yes No If yes, please explain. Any unusual behavior? Yes No If yes, please explain. Normal behavior? Yes No If no, please explain. Any respiratory noise they've noticed? (crackles/wheezes/coughing) Yes No If yes, please explain. Nasal or ocular discharge or bubbles? Yes No If yes, please explain. When was the last shed? Any issues? Any changes in frequency of shed? Yes No If yes, please explain Any weight loss or gain? Has your pet ever laid any eggs? Yes No If yes, how frequently and how many. Any history of reproductive issues? Yes No If yes, please explain. Has your pet ever been to the vet? Yes No If yes, where? Has your pet had any previous medical conditions that has been diagnosed and treated? Yes No If yes, please explain Has your pet had any deworming? Yes No If yes, please inform us how often and the latest. Is your pet on any medications? * Yes No If yes, please inform what medications and doses. What is the current issue to be addressed for the appointment? How long has this problem been an issue? Has it gotten worse or better, stayed the same or intermittent? 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