Reptile History Form

Your Information
Pet Parent*
First Last
Phone
Email*
About Your Pet
Pet's Name*
Common Species Name*
Date of Birth/Age
Sex
- Male
- Female
Date Acquired
MM slash DD slash YYYY
Acquired From
Date Last Shed
MM slash DD slash YYYY
Shedding Frequency
Bathing Frequency
Other Reptiles/Amphibians in the Household
Other Pets in the Household
Habitat
Cage Type
Cage Size
Cage Materials (including bedding)
Decoration/Furniture:
Ventilation:
Heating Equipment:
Highest Temperature:
Surrounding Room Temperature:
Highest Humidity Level:
Source:
Light Type:
Last Bulb Change:
Cleaning Products Used:
Cleaning Frequency:
Other:
Diet
Food Type:
Amount Per Feeding:
Feeding Frequency:
Water Supply:
Supplements:
Supplement Frequency:
Other:
Medical History
Primary Complaint:
Duration:
Previous Health Concerns and Procedures:
Current Medications:
Previous Medications:
- To help our veterinarian better understand your pet’s environment, we encourage you to take pictures of the enclosure and have them available during your pet’s exam.
- Also, as part of your pet’s initial exam, we recommend that you bring in a fresh fecal sample. This sample will be sent to the lab and tested for internal parasites.

93200

Your Information