Reptile Medical History

For our records

This is my current contact information

My contact information has changed and I need to update my records

Pet's Name

Owner Name

First

Last

Species

How did you obtain your pet?

Wild caught

captive born

captive bred

Place acquired/previous owner

How long have you been keeping this individual

Any recent contact with other reptiles, please give details?

When was the last new reptile added to your collection?

Date of last skin shed

How often has shedding occurred?

Describe any reproductive history or egg-laying:

Purpose of visit today

If illness, describe signs, duration, and severity:

List any medications you are giving:

Describe any changes in droppings (urine, urates, or feces)

Describe any recent changes in behavior:

Have any other animals or people in the household been sick lately?

Describe any previous illness and treatment:

List previous veterinarian, if any:

Diet

What food items are offered:

What is eaten:

How often fed

Method of feeding (e.g., live, fresh killed, thawed,blended):

If diet includes insects, are they fed and watered before being offered to the reptile?

Describe items provided as feed to the insects:

Any vitamin/mineral supplements including brand name:

Water

Dimensions of dish or tank (including depth):

How often is container filled?

How often is container cleaned?

Housing

Dimensions & building materials of cage:

Describe cage furnishings:

Type of bedding/substrate:

Frequency of cage cleaning:

Method of cleaning/products used:

Kept alone or with how many others:

What other species:

Temperature range: at basking site:__________ away from basking site:________nighttime:________

Describe thermometer(s) in use:

Describe heating equipment (ceramic heat emitter,under-tank heater, light bulb, aquarium heater, thermostat control, etc):

Humidity range:

Lighting: Type and brand name of lamp:

Hours of light per day:_________ Is the light on a timer?________ How old is the bulb?

Any access to natural sunlight?_______ If so, is it through glass or screen?

Handling

How often:

By whom:

STATEMENT OF FINANCIAL RESPONSIBILITY

Name / Signature

First

Last

Date

Reptile Medical History

How're We Doing?

Get In Touch

Brook-Falls Veterinary Hospital & Exotic Care