Clio Animal Hospital

SMALL ANIMAL & EXOTIC PRACTICE

3474 W. Vienna Rd. Clio, MI 48420 · Phone: (810) 687-1972 · Fax: (810) 687-2324

www.clioanimalhospital.com · Like us on Facebook

Kendra Reynolds, D.V.M

Reptile History Form

General History

Pet Name ______Species ______Age ______

Was your pet sexed ______Sex: M____F_____ Unknown _____

If your pet was a female, has she produced eggs or given birth ______

How did you acquire your pet Store ______Breeder ______Other ______

Are there any other pets in the same enclosure with this pet ______

When was your reptile’s last shed______

Was it a normal shed ______

Housing

Is your reptile kept in an enclosure ______Roams free in the house ______

Describe your reptile’s enclosure (size, material, etc) ______

What is the heat source ______

Enclosure temperatures: Day high/low ______Night high/low ______

Basking site temperature ______

How is humidity provided ______

Enclosure humidity: Percent humidity ______

How are heat and humidity measured in the enclosure ______

What is/are the light sources ______

Is there a UVB or full spectrum light source ______How many hours/day ______

What substrate is used in the enclosure (sand, newspaper, etc) ______

How often is the enclosure cleaned, and with what products ______

Do you soak your reptile and how often? ______

Do you mist the enclosure and how often? ______

Diet- What Does Your Reptile Eat?

When did your reptile last eat ______

Snake owners:

Do you feed frozen or live:______

What does your snake eat: ______

Lizard and Turtle/Tortoise owners:

Kinds of greens and how often: ______

Kinds of fruits and how often: ______

Kinds of veggies and how often: ______

Kinds of protein and how often: ______

All Reptiles:

How often is your reptile fed ______

If insects are fed, are they gut loaded before being fed to your pet ______

If so, with what product(s) ______

What kinds of supplements / vitamins do you give your reptile and how often do you give them? ______

Does your reptile get treats, and what kind ______

How is water offered (bowl, dropper, etc) ______