Owner First Name *
Owner Surname *
Owner Phone Number *
Reptile'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 reptiles/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? *
What is used to clean the enclosure, and how often? *
How much time is spent out of their enclosure? *
List the heat sources in the enclosure (basking globe, hat mat, etc.) *
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)?
What type of UVB supplementation is provided (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?
Do they get any direct sunlight (not through a window or glass)? If so, how often, and for how long? *
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, bathing)? *
When did they last shed, and was it normal? *
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 reptiles 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 breathing changes? *
Have you noticed any coughing or sneezing? If so, describe the frequency, and when it was first noticed. *
Has there been a recent change in behaviour (e.g. seeking the cold)? If so, please describe. *
Has there been a recent change in thirst or appetite? If so, please describe. *
Please list any known health issues, medical problems, or long-term medications. *
Aquatic Reptiles: what is the water temperature?
Aquatic Reptiles: how often is the water changed, and what percentage?
Aquatic Reptiles: how often is the water tested? What were the most recent results?
Aquatic Reptiles: does the water have filtration? Describe:
Do you have any questions for the vet which haven't been mentioned in the above history questions?
