• AQUATIC ANIMAL HISTORY FORM

    A detailed history is essential to provide the most appropriate veterinary care for your animal. Please complete this form as accurately as possible. If there is anything you are unsure about you can discuss it in more depth with the veterinary staff during your appointment.
  • Format: (000) 000-0000.

  • FISH, INVERTEBRATES & TREATMENTS

  • Sex*
  • Origin*

  • REASON FOR PRESENTATION TODAY

  • Do You Operate A Quarantine System?*
  • Has Any Disease Been Diagnosed In ANY Fish Or This Tank Previously?*

  • Have You Treated With Any Of The Following Products?

  • Formalin, Formaldehyde*
  • Potassium Permanganate*
  • Copper*
  • Salt (Freshwater Fish Only)*
  • Malachite Green*
  • Antibiotics (e.g. Oxytet, Nitrofurazone, Sulphonamides)*
  • Antiparasitic Drugs (e.g. Fenbendazolem Metronidazole, Praziquantel)*

  • AQUARIUM ENVIRONMENT

  • What Type Of Aquarium Is Used?*
  • What Water Source Is Used?*
  • What Type Of Water Change System Do You Operate?*
  • Do You Use Biological Filtration?*
  • Do You Use Mechanical Filtration? (e.g. Sponge Filters)*
  • Do You Use Chemical Filtration? (e.g. Activated Charcoal, Chlorine))*
  • Do You Use Ozone?*
  • Do You Use Protein Skimmers?*
  • Do You Oxygenate The Water?*
  • Are Plants Present?*
  • Do You Quarantine Plants?*
  • Is Additional Lighting Provided?*
  • If Yes, What Type Of Light Is Used?
  • Is There Ever Access To Direct Sunlight? (Not Through Glass Or Plastic)*
  • Do You Measure Ammonia?*
  • Do You Measure Nitrite?*
  • Do You Measure Nitrate?*
  • Do You Measure pH?*
  • Do You Measure Water Oxygen?*

  • DIET & NUTRITION

  • Indicate which foods are eaten and in what amounts (by number, weight, or approx. volume):

  • Flakes: * . Brand: *. Amount: *.

  • Pellets: * . Brand: *. Amount: *.

  • Plant/Produce: * . Type: *. Amount: *.

  • Invertebrates: * . Type: *. Amount: *.

  • Vertebrates: * . Type: *. Amount: *.

  • Do You Use Any Nutritional Supplements?*
  • Should be Empty: