Reptile History QuestionnaireOwner InformationName(Required) First Last Phone(Required)Email(Required) Reptile InformationName(Required)Species(Required)Where did you get your pet?(Required) Shelter Breeder Pet Store OtherPlease specify(Required)How long have you owned your reptile?(Required)What other reptiles do you have in this cage?In the same room?In the house/yard?Is your pet(Required) Captive born Wild/import UnknownCage SpecificationsSize of cage(Required)Construction materials(Required)SubstrateCleaning routine(Required)How is the cage heated?(Required)Is there a thermometer?(Required) Yes NoWhat kind?Daytime high temperatureAt basking siteDaytime low temperatureAway from basking siteNighttime low temperatureWhat type of lights are used?(Required)How many hours of light per day?(Required)Is the light on a timer?(Required) Yes NoAre ultraviolet lights present?(Required) Yes NoWhat is the brand name of the ultraviolet lights?How frequently do you change the ultraviolet lights?(Required)List all items fed to your reptile(Required)How often do you feed your reptile?(Required)How do you provide water?(Required)How often is the water cleaned or changed?(Required)Do you have quarantine procedures for new animals?(Required) Yes No Not applicableWhen was a fecal (poop) sample last checked?(Required) Less than 1 year ago Over 1 year ago NeverWhat prior illness or health issues has your reptile had?(Required)What prior illness or health issues have any cage-mates had?Has this reptile had any problems with mites?(Required) Yes NoWhen was this animal’s last normal shed?(Required)What health issue are we seeing your reptile for today?(Required) 45177 Get In TouchOur goal is to get ahead of any potential problems through regular care and help provide the best life possible for your pet.Contact Us
