Reptile Questionnaire At Country Club Animal Clinic

Owner's Name *

When did you get your pet? (mm/dd/yyyy)

Is your pet kept in a cage, aquarium, or free in the house? (Please describe)

Is your pet with other pets, if so how many and what kind

What signs have you noticed regarding this pet, this incident? (Check all that apply)

Has your pet received any treatment for this problem?

Are you using a thermometer and a humidity gauge?

What's the average temperature of your cage/aquarium during the day?

What's the average temperature of your cage/aquarium at night?

What's the average temperature of your cage/aquarium in the basking area?

Do you have a UVB light?

Do you have a way to keep your pet warm at night? (Please describe)

Does your pet ever go outside?

How often do you change out the paper or litter of the cage?

How often do you thoroughly clean your pet's cage/aquarium and what do you use to clean it? (Please describe)

How do you provide your pet water and how often is the water changed?

How often do you clean your pet's dishes?

Does you pet eat pellets, fruits, vegetables, or insects? (Please describe)

Do you give any supplements and if so what kind?

How much food do you feed your pet?

How often do you offer fresh food?

Has your pet had any recent diet changes?

Have there been any recent changes in your pet's cage/environment? (Please describe)