Exotic Animal History Form
Thank you for filling out our Exotics History Form.This information will help our team better serve your pet.
Client Information
Clients Name
*
First Name
Last Name
Patient's Name
*
Current Illness (write "none" if no current illness)
*
Current Medications (write "none" if no current medications)
*
Diet
Current Diet
*
How Much?
*
How Often?
*
Brand of Food Used
*
Vitamins
*
Treats
*
Water
Water:
*
Bottle
Bowl
Water Changed (times/day)
*
Housing
Location
*
Outdoors
Indoors
Both Outdoors and Indoors
If Indoors, what specific location?
*
Enclosure Made Of
*
Dimensions
*
Bedding Used
*
Brand of Bedding Used
*
Other
Exercise
Exercise
*
Lighting
Do you use lighting for your pet?
*
Yes
No
Current Lighting
*
Location Relative to Pet
*
How Many Hours Daily
*
How Often Bulbs Changed
*
Time Spent Outside
*
Temperature/Humidity
Does your pet require temperature control?
*
Yes
No
Day
*
Night
*
Basking Area?
*
Heat Source
*
Humidity Current %
*
Mist/Soak?
*
Other
Other information you'd like to provide:
Signature
*
Today's Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: