Email *
Name *
Species (and subspecies if known) *
How was your animal sexed? (visual, blood test, surgical or probes) *
Is there any specific identification? (ie: tattoo, microchip) *
If yes, please describe *
was Additional day
If other, please specify *
Date acquired *
Approximate Age *
How long have you had it? *
When and with what was it last de-wormed? *
If yes, please specify, including ages and when acquired *
When did your reptile last shed its skin? *
Did the shed appear normal? Please describe *
Percentage of time spent indoors *
Percentage of time spent outdoors *
Percentage of time spent roaming free in the house *
What is the vivarium made of? *
What are its measurements? *
How is ventilation provided? *
If yes, please describe *
What type of tube is used and how frequently is it changed? *
How high above the cage bottom is the UV positioned? *
What type, temperature, and wattage? *
For how long are the lights on each day in the summer? *
For how long are the lights on each day in the winter? *
What type of heater is used? *
Does it have a guard around it/ do you have a hot rock? *
What is the temperature of the tank during the day? *
What is the temperature of the tank at night? *
What is the temperature of the tank in the summer? *
What is the temperature of the tank in the winter? *
What is the temperature under the spotlight/basking light? *
What is the temperature difference between the hot end and the cold end? *
Please describe fully the process of cooling down, length of cooling and warming back up. *
What is the humidity? *
How is the humidity provided? *
What bedding is used? *
How deep is the bedding? *
How frequently is the vivarium cleaned out? *
What cleaning solution is used? *
Describe the hide boxes *
What other items of décor are there? (rocks, branches, drain pipes, plastic or real plants, etc.)
List all foods including quantity and frequency *
How often is the animal fed? *
What vitamins or supplements are provided and how often? Please include brand name(s)
What insects are given? *
If live insects are fed, are they offered food at home (“gut loaded”) before being fed to your reptile? If so, with what product?
How is water offered (ie: sipper bottle, bowl, dropper)? *
What size is the water container? *
If yes, please describe *
If yes, where and for what time period? *
If so, how often and where? *
What signs have you noticed that prompted today’s visit? *
How long have you noticed the problem? *
If yes, when/why? *
If other, please specify *
Additional comments regarding the reason for this visit
