Chicago Exotics Fish History Form
Pet’s Name: ______Owner Name: ______
Species: ______Breed: ______Age: ______
Color: ______Gender: M F Unknown
How was pet sexed: Physical Traits Ultrasound Unsure Other: ______
This fish is a: Pet Breeder Is your pet: Wild Caught Domestically Bred Imported
Where did you get your pet: Breeder Pet Store Friend/Family Rescue Found/Caught
Was your pet quarantined: Yes No If yes, how long and where: ______
What type of enclosure: Aquarium Pond Indoors Outdoors Fresh Water
Salt Water Brackish Other: ______
How big is the enclosure: ______How often do you clean: ______
What other animals/plants/coral live in the enclosure: ______
______
What type of cage furnishings do you have: Natural Branches Fake Branches Real Plants
Plastic Plants Silk Plants Hides Rocks Other: ______
What is on the bottom of the enclosure: Bare Sand Large Gravel Small Gravel
River Rock Silt Other: ______
Do you have supplemental heat: Yes No What type of heater: ______
Do you have supplemental cooling: Yes No What type of cooler: ______
What is the temperature of the water: ______What is the light cycle: ______
How often is water changed: ______How much water is changed: 1/4 1/2 1/3 Full
How often is water chemistry tested: ______Brand of water test kit: ______
What type of filter: Canister Bio Wheel Power Filter Under Gravel Other: ______
How often is filter media cleaned: ______How often is filter media changed: ______
Do you have an aeration system: Filter Aerator Stone None Other: ______
What type of lighting does your tank receive: None Fluorescent UVB
In the case of pond fish, do you bring them in during the winter: Yes No
What is the pH of the water: ______What type of water: Dechlorinated Aged Distilled Tap
What additives do you put in water: ______