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946 Lake Baldwin Lane
Orlando, FL, 32814
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Reptile & Amphibian Health History
Client Name
*
Email
*
Phone
*
Your concern today?
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ABOUT YOUR REPTILE
Species
*
Age
*
Species
*
Male
Female
Unknown
Reproductive History: History of egg laying, breeding, sterilization surgery
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How long have you owned this pet?
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Where did you acquire your reptile?
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Breeder
Expo
Pet store
Wild caught
Rescue/Adoption
Shed cycles: Most recent shed? Frequency of sheds?
Past illnesses or significant medical history
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Any changes to appetite, thirst, urination, defecation?
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Changes in behavior?
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ABOUT THEIR HUSBANDRY
DFeeding: method of feeding, frequency, last meal
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Food items: specific types of proteins, specific greens (veggies, fruits, grasses) frequencies of offering each. Any wild animals or insects fed?
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Supplements: calcium +/- Vit D3, multivitamin? Frequency of each.
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Water source: Describe size and location in enclosure
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Is reptile alone in enclosure or cohabitated?
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Alone
Cohabitated
Heating: What sources of light are used (day/night lights, colors of bulbs) and how long are they on?
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UV Bulb: What type/brand of bulb? UVA and UVB? When was last replaced? Inside or outside enclosure?
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Outdoor time: Exposure to direct sunshine and outdoors? How often?
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Enclosure: Size of enclosure, what is enclosure made of (glass, plastic, wood, metal ...), substrate material, what furniture is inside enclosure?
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Attach photo of enclosure
Humidity: Do they measure? What is it? How do they humidify enclosure?
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Temperature: How do you measure temperature? What is temperature at basking spot and coolest spot during the day? What is temperature of warm side and cool side at night?
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Where is enclosure located? Near windows? Reptile room? Outdoors?
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Any exposure to other pets/animals in home?
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Yes
No
Frequency of handling?
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Cleaning: How frequent is enclosure cleaned? With what products?
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