Your Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
LIZARD
Getting To Know Your Scaley Companion
YOUR LIZARDS NAME:
SPECIES:
AGE:
EXACT BIRTHDAY OR APPROXIMATE AGE
SEX:
If Female, has she been spayed?
Please Select
YES
NO
How do you know that your lizard is Male/Female? Probed, laid eggs, etc.
CURRENT HISTORY
Please let us know what is currently going on.
Reason For Visit:
How long has this issue been going on?: (If coming in for overall checkup, skip this question)
Have you seen a veterinarian for this illness/problem?
Please Select
YES
NO
Current Medications:
Any side effects of the medications?
Please Select
YES
NO
If yes, please describe symptoms:
Any improvements on the medications?
Please Select
YES
NO
If yes, please describe those improvements:
Coughing?
Please Select
YES
NO
Sneezing?
Please Select
YES
NO
Nasal or oral discharge?
Please Select
YES
NO
Diarrhea?
Please Select
YES
NO
Vomiting/Regurgitation?
Please Select
YES
NO
Problems with shedding?
Please Select
YES
NO
Change in appetite?
Please Select
YES
NO
Change in defecation?
Please Select
YES
NO
When was last egg (or eggs) laid?
When was last shed?
When was last defecation?
PAST HISTORY
Where did you obtain your pet? Pet store, craigslist, breeder, other.
How long have you had your pet?Where did you obtain your pet? Pet store, craigslist, breeder, other.
What veterinary practice do you usually go to?
Any medical history?
Please Select
YES
NO
If Yes, please upload any history you have.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
CARE DETAILS
Please describe your lizards enclosure. Size/Type and Location in your home.
Please tell us about your lizards enclosure set up & furniture.
Hiding places, logs, branches for climbing, rocks?
Substrate/Bedding Type:
How often do you clean the enclosure :
DIET
Do you feed insects to your lizard? (If No, skip to question 4)
Please Select
YES
NO
1. If yes, what type of insects? (Crickets, mealworms, king worms, wax worms)
2. Do you gut load the insects prior to feeding?
Please Select
YES
NO
3. What percentage of diet is made up of insects?
4. Do you feed salad to your lizard? (If No, skip to question 7)
Please Select
YES
NO
5. If yes, what salad items do you feed? Please be Specific! - What greens, fruits, vegetables?
6. What percentage of diet is made up of salad?
7. Do you feed a pelleted diet to your lizard? (If No, skip to question 10)
Please Select
YES
NO
8. If yes, what is the brand and amount fed?
9. What percentage of diet is made up of pellets?
10. Do you feed any other items to your lizard? (If No, please skip to question 13)
Please Select
YES
NO
11. If yes, please let us know what other items, how often and the amount you are feeding?
12. What percentage of diet is made up of these "other items"?
13. Do you give supplements or vitamins? (If No, please skip to question 16)
Please Select
YES
NO
14. If yes, what brand?
15. How often?
16. When was the last meal?
WATER
Is the bowl large enough for your lizard to bath/submerge in the water?
How often is it cleaned?
Do you offer bathing/soaking opportunities for your lizard?
Please Select
YES
NO
HEAT & LIGHT SOURCES
Is there a thermometer(s) in the enclosure?
Please Select
YES
NO
If so, what type of thermometer(s)?
Where is it or where are they located in the enclosure?
What are both the daytime and nighttime temperatures in the enclosure?
What heat sources are used in your enclosure?
Under tank heater?
Please Select
YES
NO
Under tank heater (NO light emitted)?
Please Select
YES
NO
Above tank light heater (colored light vs white light)?
Please Select
YES
NO
What light sources are used in the enclosure?
What Brand is the light?
Does the light provide full spectrum UVA/UVB?
Please Select
YES
NO
When was the light last changed?
What distance is the light source from your pet? (shortest distance?)
HUMIDITY
Do you have a humidity meter (hygrometer) in your reptile's enclosure?
Please Select
YES
NO
If no, what sources of humidity do you have for your lizard?
If yes, what type of humidity meter is used?
If yes, where is the meter located?
If yes, what are the readings in the enclosure?
OTHER PETS IN YOUR HOME
Do you have other pets in your home?
Please Select
YES
NO
If yes, which one(s) have direct contact with your lizard?
A DAY IN THE LIFE
A typical day for your lizard
How much is your lizard handled?
Is your lizard handled by children? Please list the age range(s).
SALMONELLA
Do you know that your lizard carries the bacteria Salmonella?
Do you know how to protect your family from contracting the bacteria Salmonella?
Submit
Should be Empty: