Reptile & Amphibian History and Husbandry Questionnaire
All fields marked with * are required and must be filled.
Please complete the following questionnaire to help us better understand your pet’s health, environment, diet, and husbandry.
Name
*
First Name
Last Name
Pet's Name
Species
Approximate Age
Sex
Male
Female
Unknown
Other
When did you obtain your pet?
How old was your pet when you obtained them?
Where did you obtain your pet?
Housing & Environment
If you would like, please send us a picture of your housing setup along with the patient’s first and last name to redwoodvet@yahoo.com.
Where is your pet primarily kept?
Glass aquarium/terrarium
PVC enclosure
Screen enclosure
Plastic enclosure/tub
Outdoor enclosure
Other
Approximate enclosure dimensions
Length | Width | Height
Does your pet have access to an outdoor enclosure or natural sunlight?
Yes
No
If yes, please describe:
Are there other pets in the household?
Yes
No
If yes, please list the species and number of animals:
Enclosure & Substrate
What substrate/material is used in the bottom of the enclosure?
How deep is the substrate, if applicable?
How often is the enclosure cleaned?
What types of hides, climbing structures, plants, water features, or other enrichment are provided?
Heating & Temperature
What type(s) of heating source are used?
Temperature on the cool side:
Temperature on the warm/hot side:
Temperature directly under the basking area:
How are temperatures measured?
Digital thermometer
Infrared temperature gun
Analog thermometer
Other
UVB & Lighting
Does your pet receive UVB lighting?
Yes
No
What type/brand of UVB light is used?
Approximately how far is the UVB light from your pet?
Is there glass, plastic, or another barrier between the UVB light and your pet?
Yes
No
When was the UVB bulb last replaced?
Approximately how many hours of light does your pet receive each day?
Humidity & Water
Average humidity within the enclosure:
Does your pet have access to a water bowl or other water source?
Yes
No
Diet & Feeding
What does your pet primarily eat?
How often is your pet fed?
Please describe any additional foods or treats provided:
Is your pet fed inside or outside of the enclosure?
Inside the enclosure
Outside the enclosure
Both
How is food presented?
Food bowl
Feeding dish
Hand-fed
Tongs/forceps
Free-roaming insects
Other
Supplements
Does your pet receive any vitamin, mineral, calcium, or other supplements?
If so, what supplements are used and what brands are they?
How often are supplements provided and how are they administered?
Medical History
Has your pet had any significant previous medical conditions or illnesses?
Yes
No
Unknown
If yes, please describe:
Pet Owner Signature
*
Today's Date
*
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