Reptile History Questionnaire

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MM slash DD slash YYYY

Name







Has your pet ever had a problem in the past?


Housing

Do you have other reptiles?


Are they in the same cage as this one?


Is your pet at room temperature?


Do you control the temperature and humidity of the cage?


Does your pet get exposed to unfiltered sunlight at least a few days a week? (Not through glass or plastic; screen is ok)


Do you use a UVA/UVB bulb?


Is the bulb over 6 months old?


Diet

How much is your pet eating?




Do you gut load (feed supplements) to your pet's insects?


How much is your pet drinking?




Do you give vitamin/mineral supplements directly?


Shedding and Behaviors

Is your pet shedding regularly?


Was it full or partial?


Do you mist or soak?


Additional Information

In order for our doctors to do a complete analysis for a diagnosis, do we have your permission to perform the following, if needed?
X-rays ($65)


Ultrasound ($45)



MM slash DD slash YYYY

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






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