Reptile Questionnaire Please enable JavaScript in your browser to complete this form.OWNER INFORMATION Name: *Phone Number: * PATIENT INFORMATION Name: *Species: *Date of birth/hatch: *Gender: *MaleFemaleSpayed/neutered: *MaleFemaleHow do you know the gender of your reptile? *DNASurgicallyPhysical traitsProbeUltrasoundWhere did you obtain your reptile? *BreederPet storeFriend/FamilyRescueFound/caughtHow long have you had your reptile? *What other pets are kept in the house? * ENVIRONMENT What type of enclosure does your reptile live in? *What is the height of the enclosure? *What is the width of the enclosure? *What is the length of the enclosure? *What type of cage furnishings do you have? *Natural branchesFake branchesFoliageReal PlantsStonesDig boxWater bowlHide boxOtherPlease explain other:What is on the bottom of the enclosure? *NewspaperCorn CobKitty LitterTowelTilePaper towelWood shavings/chipsRubber matIndoor/outdoor carpetDirtMossBare gravelCalci-sandPlay SandOtherPlease explain other:What is the day time temperature? *What is the night time temperature? *What is the basking site time temperature? *Do you have a thermostat? *YesNoDo you have a thermometer? *YesNoLocation of thermometer:Do you have a hygrometer? *YesNoHow do you heat the enclosure? *Light bulbsHeat cableHeat tapeUndertank heatersHot rockCeramic heat emittersMercury bulbsRoom heaterWater heaterOtherPlease explain other:What is the humidity of the environment? *How do you control the humidity? *Humidifier in roomMister/foggerDrip systemSprayingOtherPlease explain other:How is water offered? *DishTrayDropper/misterPortion of cageAquaticSoakingOtherPlease explain other:How is water filtered? *In-tank filterBio-wheelCanisterNoneHow often is the water changed? *What strength of UVB bulb do you have? *2.05.010.0How often do you replace your UVB bulb? *Does your pet get natural sunlight? *YesNoHow does your pet get natural sunlight? *How much natural sunlight does your pet get? *How long are the lights on during the day? *How long are the lights on during the night? * DIET What do you feed your pet? *How often do you feed your pet? *How often does your pet defecate? *Do you use any vitamin/mineral supplements? *YesNoWhat vitamin/mineral do you use? REASON FOR PRESENTATION TODAY What are the primary signs you have noticed? *How long have these problems been present? *What health problems has your pet had previously? *Has your pet received any treatment in the last 30 days? *YesNoIf yes, please give detail (what was used, dosage, duration, frequency, etc.)Have you noticed any changes in your pets behavior? *YesNoHave any other animals in the household had any illness in the last 30 days? *YesNoIf yes, please describe:Submit
1350 S Fish Hatchery Rd. Oregon, WI 53575