Owner Name

Pet Name

Species of Reptile

Age

How long have you owned him/her?

Any Cage Mates?

List Other Reptiles on the Premises

Has your pet been to a vet before? If so what for?

Any preventative medicine such as stool sample test, bloodwork, etc.?

Any previous illnesses?

What does your pet eat?

How Often?

Do you use a calcium and vitamin supplement? Please list brands.

Do you gut load insects? If so with what?

When was the last time your pet ate?

Describe the enclosure

What substrate is used, if any?

What are the temperatures on the cool end, warm end, and basking spot?

What is the average humidity? Do you use a humidity box/hide?

Do you have a UVB light? If so, how often is it changed?

How is water provided?

What’s the reason for your visit today?

Anything else we should know about your pet?