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Reptile History Form

Save time during your next appointment! Please fill out our Reptile History Form online from any device at any time before your visit.

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Online Form

Reptile History Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet’s before your visit.

Owner's Name *

First

Last

Email *

Animal Details

Name *

Species (and subspecies if known) *

Sex *

Male
Female
Unknown

How was your animal sexed? (visual, blood test, surgical or probes) *

Is there any specific identification? (ie: tattoo, microchip) *

Has your reptile produced eggs or given birth to young in the past? *

Yes
No

If yes, please describe *

The reptile is a: *

Pet
Breeder

Where did you get it from? *

Store
Breeder
Other

If other, please specify *

Date acquired *

Approximate Age *

How long have you had it? *

When and with what was it last de-wormed? *

Do you have any other pets? *

Yes
No

If yes, please specify, including ages and when acquired *

When did your reptile last shed its skin? *

Did the shed appear normal? Please describe *

Housing

General

Please specify the percent of time the reptile spends in each location.

Percentage of time spent indoors *

Percentage of time spent outdoors *

Percentage of time spent roaming free in the house *

Vivarium

What is the vivarium made of? *

What are its measurements? *

How is ventilation provided? *

Has your reptile’s environment changed recently? *

Yes
No

If yes, please describe *

Lighting

Is there a UV or full spectrum light? *

Yes
No

What type of tube is used and how frequently is it changed? *

How high above the cage bottom is the UV positioned? *

Is there a spotlight/basking light? *

Yes
No

What type, temperature, and wattage? *

Does the heat light have a guard around it? *

Yes
No

Do you have a hot rock? *

Yes
No

For how long are the lights on each day in the summer? *

For how long are the lights on each day in the winter? *

Heating

What type of heater is used? *

Does it have a guard around it/ do you have a hot rock? *

Is it connected to a thermostat? *

Yes
No

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? *

Do you use min/max thermometers? *

Yes
No

What is the temperature under the spotlight/basking light? *

Is all the heating and lighting equipment at the same end of the vivarium? *

Yes
No

What is the temperature difference between the hot end and the cold end? *

Cooling Down

Please describe fully the process of cooling down, length of cooling and warming back up. *

Humidity

What is the humidity? *

Is there a humidity gauge? *

Yes
No

How is the humidity provided? *

Décor

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 *

Is there a covered, damp, moss/peat container? *

Yes
No

What other items of décor are there? (rocks, branches, drain pipes, plastic or real plants, etc.)

Feeding

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? *

Any recent diet changes or new foods? *

Yes
No

If yes, please describe *

Social Grouping

Do you have multiple reptiles in the same enclosure? *

Yes
No

What other individuals of the same or different species share the accommodation? *

How many are there of each and what sex? *

Do they tend to mix with or ignore each other? *

Mix
Ignore each other

Is there at least one hiding place per individual? *

Yes
No

Miscellaneous

Does your reptile hibernate? *

Yes
No

If yes, where and for what time period? *

Do you soak your reptile? *

Yes
No

If so, how often and where? *

Reasons for Today’s Visit

What signs have you noticed that prompted today’s visit? *

the how least

How long have you noticed the problem? *

Has your reptile been sick previously? *

Yes
No

Has any other veterinarian ever seen your reptile? *

Yes
No

If yes, when/why? *

Have any tests been performed previously on your reptile? Please check all that apply: *

Bloodwork
Fecal parasite test
Radiographs (x-rays)
Other
None of the above

If other, please specify *

Additional comments regarding the reason for this visit

Are you aware that reptiles can carry the salmonella virus? If not, please ask us to explain.

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We proudly serve the pets of Grafton, Cedarburg, Port Washington, Saukville, Mequon, Thiensville, West Bend, and beyond. We look forward to seeing you and your pet soon. Book an appointment by clicking the button below.

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Location

2082 Cheyenne Ct.
Grafton, WI 53024

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Contact Information

Email: info@bestfriendsvet.com

Phone: (262) 375-0130

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Hour

Monday, Thursday: 7:30AM – 6:00PM

Tuesday, Wednesday: 8:30AM – 6:00PM

Friday: 8:30AM – 5:00PM

Saturday: 8:30AM – 1:00PM

Sunday: Closed

CONTACT US

Have a question?

Get in touch! Please complete the form, and a member of our veterinary team will reach out shortly.

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Last

Email *

Phone

How can we help you? *

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