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Reptile History

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Reptile History

Reptile History

Client #

Owner’s Name

Animal’s Name

Date

MM slash DD slash YYYY

Patient Information

Species:

Gender:

Date of birth/hatch:

MM slash DD slash YYYY

Date acquired:

MM slash DD slash YYYY

Source (pet store, breeder, previous owner):

Source:

Captive Bred

Wild Caught

Environment

Where is this reptile kept in the house?

Cage: type, size:

What is on the bottom of the cage?

What types of hiding places are provided?

List species of live plants:

Is there a soaking/swimming tub?

Please describe other furnishings:

How often is the cage cleaned, what cleaning products are used?

Answer these questions if your reptile is aquatic:

How often is the water changed?

What type of filtration is used?

Do you use a dechlorinator or any other type of water treatment?

Lighting

Does your reptile receive sunlight?

Yes

No

Estimated hours per week

Does the sunlight pass through glass or plastic before reaching the reptile?

Yes

No

Artificial lighting - incandescent (“screw-in” bulbs):

Yes

No

Wattage(s)

hours/day

Artificial lighting - fluorescent (tube bulbs)

Yes

No

Brand(s)

hours/day

Temperature

Do you have a thermometer(s) in the cage?

Yes

No

What is the temperature in the warmest part of the cage?

In the coolest part?

What device(s) are used to maintain the temperature?

Hot Rock

Heat Pad

Warm Room

Heat Light

Ceramic Heater

Aquarium Heater

Other

Is there a thermostat?

Yes

No

Is the temperature decreased at night?

Yes

No

By how much?

Humidity

Is the cage misted?

Yes

No

How often?

Is the humidity measured?

Yes

No

Range:

How much time does your reptile spend outside of the enclosure?

Is your reptile supervised when it is out?

Always

Sometimes

No

Is supplemental heating provided outside the cage?

Yes

No

Type

Have you ever noticed your reptile eat any household objects?

Is the reptile ever taken outdoors?

Yes

No

Describe

Does your reptile hibernate? Please describe the duration, temperature, and monitoring you provide during hibernation.

Do you have other pets?

Yes

No

List other animals that are kept in the same cage:

Recent acquisitions (new pets within the past 6 months) – species, date, source:

List any other pets you have:

Are any of your other pets ill?

Yes

No

List recent changes in the environment, if any

Diet

What percent of your reptile’s diet consists of the following (please describe what the animal actually eats, rather than what is offered). Total should = 100%

Vegetable, % amount and Items

Fruits, % amount and Items

% Insects, mealworms, etc:

Are they “gut loaded” or dusted before feeding to your reptile? Describe

% Rodents, chicks, etc, list types & source:

Are they fed

Live

Killed

Both?

% Pellets, commercial diet or canned food list types:

% Other, describe

Please list any supplements used. How are they given and how often?

How often do you feed your reptile?

Does your reptile eat anything other than its intended diet (e.g. the cat’s food, houseplants)?

How is water offered (e.g. dish, misting, drip system)?

Please list any recent additions/changes in the diet:

Shedding

When was the last shed?

Was it normal?

Reproductive

Do you plan on breeding this animal?

Yes

No

Possibly

How many clutches/litters has this reptile produced?

How many live offspring?

When was the most recent clutch/litter?

How many eggs/babies were laid?

Has your reptile every had difficulty laying?

Yes

No

Describe

Has your reptile ever been tested or treated for internal or external parasites? Please describe dates and medications used:

Previous conditions, problems, surgeries (list with date, if known)

Is your reptile here for a

well pet check-up

sick

If your reptile is sick, please describe the signs and how long your reptile has been showing these signs:

Is your reptile’s general activity level

Normal

Decreased

Increased

Is your reptile’s appetite

Normal

Decreased

Increased

Have you noticed any of the following?

Weight Loss

Weight Gain

Discharge from the eyes or nose

Increased breathing rate or effort

A change in droppings

Abnormal skin color or shedding

Skin/fecal parasites

Weakness

Have you used any medications from a pet store?

Has your reptile been seen by another veterinarian for any of the current problems?

Yes

No

When?

MM slash DD slash YYYY

Please list tests performed:

Please list medications given:

Is there anything else you would like done today?

Nail Trim

Yes

No

I have a question about:

Other:

***Did you know that most reptiles carry Salmonella that can infect humans?*** Please read and keep the attached handout on Salmonella.

Office Hours

Mon – Fri: 8 AM – 8 PM

Sat: 8 AM – 5 PM

Sun: 10 AM – 2 PM

Office Info

Phone: (610) 237-6120

Address: 405 S MacDade Blvd, Glenolden, PA 19036