FISH QUESTIONNAIRE

Required fields are marked (*)

"*" indicates required fields

Name:*

First Last

Email:*

Phone:*

Address:*

Street Address Address Line 2 City State ZIP Code

How did you hear about us?

1. How long has the tank/pond(s) been in operation?

2. How many gallons in the tank/pond(s)?

3. What type of lighting (natural, incandescent, fluorescent, other)

4. How many fish are in the tank/pond?

5. Please describe the filtration. Type? How often is it cleaned?

6. Is there a bottom substrate? What type?

7. What kind of plants are in the tank/pond?

8. Is there a bottom drain, surface skimmer or protein skimmer

9. Is there a UV sterilizer?

10. What is the source of water? Is it dechlorinated?

11. How often is the water tested? What test kits are used?

12. What were the most recent readings for ammonia? pH? nitrite? nitrate? alkalinity? other?

13. How often is water changed? What quantity?

14. What water treatments are used - softener, ion exchanger, sodium bicarbonate, potassium permanganate etc.? Include frequency

15. Please name the types/brands of feed (include live food if applicable).

16. How much food is given and how often?

17. What species of fish are kept in the tank/pond? What species are affected?

18. Have there been any recent new fish introductions (how long ago and what type)?

19. If nothing recently, when was the last new fish introduced into the tank/pond?

20. Are new fish quarantined? For how long?

21. Please describe what signs the sick fish are showing.

22. When did the signs first start?

23. How many fish are affected? Have any deaths occurred?

24. Please describe what treatments have been attempted. Include names/ingredients/duration of treatment, and response to treatment.

25. Please describe any historical health problems (besides for the current problem) that you have had with your fish. Include treatments and response.

Signature

CAPTCHA

Phone

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