REPTILE NEW PATIENT FORM

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Environment and diet play a fundamental role in the health of exotic pets. In order to obtain the best assessment of your pet’s health and therefore provide the most appropriate care, it is very important that we have very detailed information regarding your pet. Please complete this form as thoroughly and accurately as possible. If you are unsure about any questions, please answer to the best of your ability or ask a veterinarian or staff member for clarification.

Client Information

MM slash DD slash YYYY
Name:*
Spouse/Secondary Name: (if applicable):
Mailing Address:*

Patient Information

Sex:
Is your reptile:

Housing

Do you use a hygrometer (humidity meter)?
Do you use thermometers?
Do you use a full-spectrum (UVB) bulb?
Does your pet get direct sunlight? (not through a window)
Are there any other reptiles housed in the same enclosure?

For aquatic species such as water turtles

Do you use a water heater?
Does the aquarium have a filter?
Do you dechlorinate the water?

Diet

(Please fill in the percent of the total diet and types of food in each category that offer your pet and what your pet actually eats)
Insects/Small rodents:
Select Live or Dead and Explain in the next field
Do you add vitamin or calcium supplements to the food?
If insects are fed, are they gut-loaded?

MISELLANEOUS

Do you soak or bathe your reptile?

Medical History

Has your reptile ever laid eggs?
This field is for validation purposes and should be left unchanged.