Owner First Name *
Owner Surname *
Owner Phone Number *
Fish'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 fish/animals at home? If so, please list. *
Do they share their tank with any other fish? If so, please list.
Were any new pets introduced into the tank recently? If so, were were they acquired from, and when? *
How big is their tank? *
What is the tank's substrate? *
What is the temperature of the tank? *
What lighting is used over the tank? *
Describe their diet: list all foods offered, including the amount, and frequency of feeding each item. *
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? *
When did they last eat? *
Describe the problem, including when it started? *
Are any other fish in the tank affected? *
Have you noticed any respiratory signs (gulping air at the surface, increased gill movements, 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. *
Have any medications or water additives been added to the tank? If so, list what was used, and when: *
Do you have any questions for the vet which haven't been mentioned in the above history questions?
