Owner First Name *
Owner Surname *
Owner Phone Number *
Amphibian's Name *
Species *
Age *
Gender * Unknown Male Female
Where were they acquired (breeder, pet shop, rescue organisation etc.) and how long ago? *
Are there any other amphibians/animals at home? If so, please list. *
Do they share their enclosure with any other animals? If so, please list.
Were any new pets introduced to the household recently? If so, were were they acquired from, and when? *
What is their enclosure made from, and how big is it? *
What is the enclosure substrate? *
List the heating/cooling sources in the enclosure: *
Do these heat sources have a thermostat attached? *
What is the temperature gradient of the enclosure during the day? *
What is the temperature gradient of the enclosure during the night? *
What is the enclosure's humidity (if known)?
Is UVB supplementation provided? If so, please describe (T5, coil, UVA/UVB): *
What is the approximate distance between the UV globe and the basking spot? *
If they have UVB supplementation, when was the globe last changed?
Describe their diet: list all foods offered, including the amount, and frequency of feeding each item. *
Are they fed inside or outside of the enclosure? *
How often do you supplement calcium, and how? What is the name of the supplement used? *
How is water provided (bowl, misting with water, fish tank)? *
What is the water temperature? *
How often is the water changed, and what percentage? *
How often is the water tested? What were the most recent results? *
Describe the water filtration system used (if any)? *
Frogs: describe any water treatments used (e.g. tap water conditioner, bottled water, etc,)
Axolotls: do they have a water chiller in their tank?
When did they last defecate, and was it normal? *
When did they last eat? *
Describe the problem, including when it started? *
If you have other amphibians in the household, are any others affected? *
Has there been a recent change in environment? *
Have you noticed any vomiting/regurgitation or diarrhoea? If so, describe the frequency, and when it was first noticed. *
Have you noticed any respiratory signs (gasping, buoyancy issues)? If so, describe the frequency, and when it was first noticed. *
Has there been a recent change in behaviour? If so, please describe. *
Has there been a recent change in appetite? If so, please describe. *
Please list any known health issues, medical problems, or long-term medications. *
Do you have any questions for the vet which haven't been mentioned in the above history questions?
