• Reptile Medical History Form

  • Patient/Owner Information

  • Date:*
     - -

  • Presenting complaint:

  • Have you noticed the following symptoms?*
  • Have there been any pets in contact with this one that have died within the last month?*
  • Has this pet been sick at any other time during the last 12 month?*
  • Has this pet been given any medications or supplements in the past 7 days?*
  • Does this pet have any previous or chronic medical conditions?*
  • Does this pet take any medications regularly?*
  • Has your pet ever been treated for internal or external parasites?*

  • Patient Information

  • Is your pet being seen for vomiting and/or diarrhea?*
  • Origin*
  • Was this pet sexed?
  • Does you reptile have any reproductive history?
  • Is your pet housed with another pet?*
  • Are there any other pets in the house?*
  • Have you had contact with other reptiles in the last 30 days?*

  • Cage/Enclosure Description

  • Lighting

  • Please select the type of artificial lighting used for your reptile:
  • Does your reptile receive sunlight?
  • Does the sunlight pass through glass or plastic before reaching the pet?

  • Temperature

  • Humidity

  • Is the cage misted?
  • Is the humidity measured?
  • Do you soak your reptile out of the cage?
  • Is your pet supervised when out?

  • Diet

  • Are the insects gut loaded and/or dusted before feeding?*
  • Does your reptile eat live or frozen animals? (Rodents, Chicks, Etc)*
  • Does your reptile pellets or a commercial diet?*
  • Does your pet graze in the yard?*
  • Do you give supplements? (Vitamin C, Calcium)*
  • How is water offered?

  • Reproductive

  • Is this animal used for breeding or do they have a breeding history?*
  • Has your reptile ever had difficulty laying?*
  • Should be Empty: