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- Sex*
- Sex determined by*
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- Origin*
- From where did you obtain this animal?*
- Does this animal have any history of breeding or laying eggs?*
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- Do you have any other pets in the household?*
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- Has the animal had any contact with any animals outside your household within the past 30 days?*
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- What type of cage/enclosure is used?*
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- What is the cage/enclosure made of?*
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- Is there ventilation (grills or mesh)?*
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- How often is the cage/enclosure cleaned?*
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- Heating equipment used:*
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- Is/are the heat source(s) screened from the animal(s)?*
- Can the animal(s) touch or access the heat source(s)?*
- Is a UVB bulb provided inside the cage?*
- UVB bulb type:
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- Is there additional lighting provided inside of cage?*
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- Are the lights screened from the animal(s)?*
- Can the animal(s) touch or access the lights?*
- Does the animal ever have access to direct sunlight (not through glass or plastic)?*
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- Do you measure the humidity in the cage?*
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- Does anyone in the house smoke or is the animal around smoke?*
- Do you use aerosolized substances/cleaners/air fresheners?*
- Have there been any changes in the environment in the last 3 months?*
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- Insects
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- Do you gut load your insects?*
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- Do you feed wild animals to your animals?*
- How is water offered?*
- Do you use any water supplements?*
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- Have you noticed any changes or have any concerns about your animal's feeding or drinking behavior?*
- Have you noticed any changes or have any concerns about your animal's droppings (fecal material, urine and urates)?*
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- Have you noticed any signs, symptoms, or changes in behavior?*
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- Does this animal have any previous medical or health problems?*
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- Have any other animals or persons in the household had any illness within the past 30 days?*
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- Has your animal received any treatments/medications in the last 30 days?*
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- Should be Empty: