Pre-appointment (Reptiles)

Reptiles 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

First

Last

Pet's Name

Species

Phone

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

If yes, how often and how long?

Have they ever hibernated before?

Yes

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?

UV

Is there UV light?

Yes

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

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

What is the humidity in the enclosure? What is it measured with?

Other Animals

Is this pet housed with other animals?

Yes

If yes, please write what and how many

Is there any other reptiles in the house?

Yes

If yes, how many

Signature

Clear

Today's Date

Phone

If you are human, leave this field blank.

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Pre-appointment (Reptiles)