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7120 E. Hampden Ave. St 101
Denver, CO 80224

Reptile History Form (CO)

Please fill this out before you bring your scaled friend into our office. This will speed up the intake process and let us get to work sooner.

1 Start 2 Complete

General History

Your Name (First and Last) *

Your Pet's Name *

Species *

Color

Gender

Male

Female

Unknown

How was gender determined?

Visual, surgical, probe, laid eggs?

When and where did you acquire your pet?

Do you have any other pets? If yes, please specify:

Housing

What type of enclosure does your pet live in?

Please also describe approximate dimensions (3ft x 1.5ft, 40gal, etc.)

Do you use a hygrometer (humidity meter)?

If so, what is the humidity and how is it measured?

How is the enclosure heated?

Light, heating pad, heat rock, etc?

Do you use thermometers?

If so, where are they located and what are the high and low end temperatures?

Do you use a UVB bulb and if so, what brand and size?

Please provide the brand and how often you replace it

Does your reptile get direct sunlight (ie not through a window)?

Yes

No

What is the substrate (bedding)?

What is the water source?

Are there plants, branches, or other climbing structures?

Please describe

Is there a hiding area?

Please describe

Are there any other reptiles housed in the same enclosure?

Please describe. Also, how long have they been together?

Does your reptile spend time outside of its enclosure?

If so, where and for how much time?

Do you soak your reptile?

If so, what frequency?

How often is the enclosure cleaned?

Please also list what products you use to clean the enclosure, if any.

Diet

What foods are offered to your reptile?

Describe percentages if possible

Do you feed live or frozen prey?

How often do you offer food?

Do you feed your reptile in the same enclosure that it lives in?

If not, please describe where you feed your pet.

If insects are fed, are they gut-loaded?

Do you add vitamin or calcium supplements to the food?

If so, what kind/brands and how often?

Medical History

Has your reptile ever been checked for intestinal parasites?

Yes

No

Please list any previous medical problems:

Has your female reptile ever laid eggs?

Yes

No

Do they normally shed skin whole or in pieces?

Whole

Pieces

Any current or recent medications? Please list types and dosages:

General

Have there been any changes in your pet's environment or diet? Please describe:

Does your reptile have any seasonal behavior changes?

Please describe

Do you have pet insurance?

Yes

No

How often are they handled?

Leave this field blank

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Reptile History Form (CO)