Aquatic Animal Husbandry Form (CO)

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

1 Start 2 Complete

General History

First Name *

Last Name *

Phone *

Email *

Your Pet's Name *

Color *

Date of Birth or Approximate Age *

Sex *

Male

Female

Unknown

How was sex determined? *

Visual/surgical/laid eggs?

Where and when did you acquire your pet? *

Do you have any other pets? What animals does this pet have exposure to? *

Nutrition

Do you offer a pellet, flake or other commercial diet? What brand? *

How much and how frequently are you feeding? *

Are you giving any supplements? How frequent? *

Housing

What type of enclosure does your pet live in? *

(Tank, below-ground pond, above-ground pond, pool, etc.)

What are the approximate dimensions or size? *

Ex 3ft x 1.5ft, 40 gal, etc?

Do you use any substrate in the enclosure? *

If so, what kind?

What furnishings or decorations are in the enclosure? What are they made of? *

Do you have any live plants or coral in the enclosure? *

If you do, do you use any additives or fertilizer in the tank?

Do you condition the water you put in the enclosure? *

If so, how do you condition your water (water conditioner, RO system, etc.)? If you use a commercial water conditioner, what is the brand? Do you perform regular water testing? How often?

What kind of filtration system do you use? *

Sponge filter, under gravel filter, waterfall filter, internal or external canister, sump, etc. How often do you change or replace your filter media?

How often do you clean the tank? *

How often do you gravel vacuum? How often and what percentage water change do you perform?

What lighting do you have on the enclosure? *

Outdoor Sunlight, Sunlight through window, fluorescent, LED, Halogen, Incandescent, etc. If using a fixture, when was the last time the bulb or fixture was changed/replaced? If using outdoor sunlight or sunlight through window, does the enclosure have direct sunlight access or is there shade and/or covering? What percentage of the day is the enclosure shaded/covered?

What temperature is the water kept at? What is the ambient temperature outside the tank? *

Do you use a heater or chiller?

Medical History

Is your pet currently on any medications? *

Please provide medication names, frequency and dose. If you're giving anything over the counter, what is the brand, frequency and dose?

Any recent changes to the enclosure? *

If yes, when and what changed?

Any history of serious health conditions known? *

Do you have pet insurance? *

Yes

Any other comments or information we should know? *

Leave this field blank

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

You are here

Aquatic Animal Husbandry Form (CO)