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Home Forms Reptile History Form

Reptile History Form

"*" indicates required fields

Pet's Name*

Owner's First Name*

Owner's Last Name*

Species*

Age*

Gender*

Male

Female

Unknown

How do you know the gender of your reptile?*

DNA

Surgically

Physical Traits

Probe

Ultrasound

This reptile is a*

Pet

Breeder

Is your pet*

Wild Caught

Domestically Bred

Imported

Where did you get your pet?*

Breeder

Pet Store

Friend/Family

Rescue

Found/Caught

Was your pet quarantined?*

Yes

No

If yes, how long and where?*

What type of enclosure?*

Aquarium

Mesh/Wire Cage

Wood Enclosure

Pond

Free Range

Rack System

Indoors

Outdoors

Specific Room

How big is the enclosure?*

How often do you clean the enclosure?*

What other reptiles live in the house?*

What style of habitat?*

Terrestrial

Aquatic

Semi-Aquatic

Arboreal

Semi-Arboreal

What type of cage furnishings do you have?*

Natural Branches

Fake Branches

Foliage

Real Plants

Stones

Dig Box

Water Bowl

Hide Box

Other

If Other, please explain*

What is on the bottom of the enclosure?*

Newspaper

Corn Cob

Kitty Litter

Towel

Tile

Paper Towel

Wood Shavings/Chip

Rubber Mat

Indoor/Outdoor Carpet

Calci-Sand

Play Sand

Bare

Gravel

Dirt

Moss

Other

If Other, please explain*

What is the day time temperature?*

Basking Site*

Night temperature?*

Humidity*

Thermostat*

Yes

No

Thermometer*

Yes

No

Hygrometer*

Yes

No

How do you heat the enclosure*

Light Bulbs

Heat Cable

Heat Tape

Under Tank Heaters

Ceramic Heat Emitters

Mercury Bulbs

Hot Rock

Room Heater

Water Heater

How do you control the humidity?*

Humidifier in Room

Mister/Fogger

Drip System

Spraying

How is water offered?*

Dish

Tray

Dropper/Mister

Portion of Cage

Aquatic

Soaking

How is water filtered?*

In-Tank Filter

Bio-Wheel

Canister

None

How often is water changed?*

What strength UVB bulb do you have*

2.0

5.0

10.0

How often do you replace it?*

What brand of bulb do you have?*

Repti-Sun

ReptiGlo

Sun Glow

Other

If Other, please specify*

Does your pet get natural sunlight?*

Yes

No

If yes, how?*

How long?*

What do you feed your pet?*

How often do you feed?*

How often does your pet defecate?*

Do you use

Calcium

Calcium with Phosphorus

Calcium with D3

Multi-Vitamin

How often do you use the calcium

How often do you use multi-vitamin

Please take a photo of your enclosure and be sure to upload it, or email it to us at [email protected].

Max. file size: 50 MB.

If your pet has been seen anywhere previously please include the name of the facility so we can obtain records ahead of time.

Signature*

Date*

MM slash DD slash YYYY

Phone

This field is for validation purposes and should be left unchanged.

Get in touch

(847) 821-6189

1101 S Milwaukee Ave Ste 102,
Vernon Hills, IL 60061

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1101 S Milwaukee Ave Ste 102,
Vernon Hills, IL 60061

Home
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Services
Resources
New Clients
- New Client Form
PetDesk
Contact Us

Make An Appointment

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