Name* First Last Pet Name*- Where did you get your Pet from?StorePrivate IndividualOtherWhen did you get your Pet?Is you pet kept in a cage, aquarium or free in the house? Please describeIs it inside/outside the house?With other pets? If so, how many and what kind?Are there any sick pets? Have any pets already died?What signs have you noticed regarding this pet, this incident? (Check all that apply) Diarrhea Blindness vomitting constipation breathing difficulty fainting lethargic eye/nostril/ear/leg bleeding injury/bitten by another pet skin bleeding itching lameness change in personality change in stool consistency change in appetite excessive water consumption coughingDescribe any other issuesHas 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?What type of bedding do you use for your cage/aquarium?How often do you change out the paper of litter of the cage/aquarium?How often do you thoroughly clean your pet's cage/aquarium and what do you use to clean it? Please describeHow do you provide your pet water and how often is the water changed?How often do you clean you pet's dishes?Does you pet eat pellets fruits, vegetables or insects? Please describe your pet's diet: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:EmailThis field is for validation purposes and should be left unchanged.
