Treatment Admission Form

Pet's Name *

Date and time of appointment?

Your Name *

First Name Last Name

What To Expect During {petsName}'s Visit:

Upon arrival, please call or text 360-683-2106 or knock on the door to let us know you are here. The doctor's assistant will come out to your vehicle and bring {petsName} into the hospital for examination while you wait in your vehicle.

Please ensure your pet is in a carrier. We will ask that you hand off your pet while standing outside your vehicle, as for safety reasons our staff cannot enter or reach into your vehicle to remove your pet.

We ask that you keep your phone nearby, as the doctor will be calling you while your pet is inside. If you do not have a cell phone, please let us know at check in and we'll be happy to bring a phone out to you when the doctor is ready to discuss the treatment plan.

After the exam and any diagnostics you may have requested when scheduling your appointment, the doctor will call you to discuss the treatment plan or further diagnostic steps. Once all treatments and payment for services are complete, we'll return {petsName} to you!

PLEASE NOTE: If you need to leave the hospital parking lot for any reason while your pet is inside, please give us a call or text and let us know that you are leaving and when you expect to return.

Please initial below to indicate that you understand our curbside procedures. If you have additional questions, feel free to ask the technician at time of check in. *

Background Information

Species of animal:

Length of time owned:

Age/date of birth:

Has your reptile/amphibian ever been sexed?

Yes No

Gender:

Male Female Unknown

Where did you get your pet?

Breeder Pet store Friend/family member Rescue Wild

Is your pet:

Wild caught Domestically bred Imported

This animal is a:

Breeder Pet

Was your pet quarantined?

Yes No N/A (no other reptiles/amphibians in house)

If your pet was quarantined, how long?

Appearance of feces:

How often is your pet handled?

Daily Occasionally Never

Is your pet ever taken outside?

Daily Occasionally Never

Husbandry Questions:

What type of enclosure: *

Aquarium Mesh/wire cage Wood enclosure Pond Free range Rack system Indoor Outdoor

Where is the enclosure located?

Size of enclosure:

How often is the cage cleaned?

What style of habitat: *

Terrestrial Aquatic Semi-Aquatic Arboreal Semi-Arboreal

What type of cage furnishings do you have? *

Natural branches Fake branches Foliage Real Plants Stones Dig box Water bowl Hide box

What is on the bottom of the cage?

Do you have a thermometer in the cage?

Yes No

What is the daytime temperature of the cage:

What is the temperature of the basking area?

What is the night-time temperature of the cage?

How do you heat the cage/enclosure?

Do you have a UVB bulb?

Yes No I don't know. Please provide more information.

What strength of UVB bulb do you have?

2.0 5.0 10.0

How often do you replace it?

What brand of bulb do you have?

Repti-Sun ReptiGlo Sun Glow

Do you have a hygrometer in the cage (measures humidity)?

Yes No

What is the humidity of the cage?

How do you control the humidity of the enclosure?

Humidifer in room Mister/fogger Drip system Spraying

Does your pet get natural sunlight?

Yes No

If so, how?

Outdoors Window

How long does your pet get natural sunlight and how often?

How is water offered?

Dish Drip system Dropper/mister Portion of enclosure Aquatic Soaking

How is the water filtered? (aquatic only)

In-tank filter Bio-Wheel Canister None

How often is the water changed?

Are there any other reptiles/ amphibians in the house?

Yes No

Are these pets housed together?

Yes No

If not housed in the same cage, where are the other reptiles/ amphibians housed? (i.e. same room, different room, can they see each other, etc)

Are there any other pets in the household (dog/cat/bird/etc)?

Yes No

If yes, please list other types of pets:

Nutrition Questions:

What do you feed your pet? Please include main diet, as well as treats, fruits, and veggies.

How often do you feed?

Please list type of food and frequency of feeding that food.

Do you use any of these supplements: *

Calcium Calcium with phosphorus Calcium with D3 Multivitamin None

How often do use use the supplements?

Please list type/frequency

Please let us know any past medical history or problems:

Please let us know any current health concerns:

Is there anything else you would like the doctor to know?

If possible, please provide us with a photo of the enclosure/cage where your pet spends the majority of their time.

Browse Files

Please upload if available.

Thank you for providing this information regarding your pet! Please press Submit below.

Reptile and Amphibian History