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Home
Our Hospital
Our Doctors
Our Support Staff
Hospital Tour
PetDesk
Careers
AAHA-Accredited Hospital
Services
Exotic Pets
Ultrasound
Wellness Exams
Vaccinations
Microchipping
Spay & Neuter
Dental Care
Surgery
Acupuncture
Herbal Medicine
Shock Wave
View All Services
New Clients
Resources
Download Our Free App
Donate to Paisley Paws
Forms & Helpful Links
Payment Options
Shop Online
Kitten & Puppy Kit
Pet Library
Pet Health Insurance
Pet Memorial
Contact Us
(715) 693-4560
Make an Appointment
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Reptile History Form
Reptile History Form
Client's Name
(Required)
Today's Date
(Required)
MM slash DD slash YYYY
Species
(Required)
Age
(Required)
Sex
(Required)
Male
Female
Type of Reptile
(Required)
Pet Animal
Breeder
Background Information
Length of time owned?
(Required)
Where acquired?
(Required)
Breeder
Pet Store
Other
Where was the reptile acquired from?
(Required)
Wild-caught or Captive Breed
(Required)
Wild-caught
Captive Breed
Deparasitized
(Required)
Yes
No
If yes, with what?
(Required)
How often is animal handled?
(Required)
Daily
Occasionally
Never
Animal ever taken outside?
(Required)
Yes
No
If yes, for how long?
(Required)
When was last shed?
(Required)
Any trouble shedding?
(Required)
Yes
No
If yes to shedding, please specify
(Required)
Fecal consistency?
(Required)
Husbandry
Type of enclosure
(Required)
Size of enclosure
(Required)
Where is the cage located?
(Required)
Cage furniture
(Required)
Cage substrate?
(Required)
Frequency of cage cleaning?
Type of disinfectant used to clean cage?
(Required)
Cage Environment
Light cycle?
(Required)
Type of lighting?
(Required)
Heat source?
(Required)
Humidity level?
(Required)
Temperature within cage:
Minimum cage temperature?
(Required)
Maximum cage temperature?
(Required)
Basking area temperature?
(Required)
Nutrition
Type of food offered?
(Required)
Amount fed and frequency?
(Required)
When last fed?
(Required)
Water source?
(Required)
Additional Pet(s) Information
Any other pet(s)?
(Required)
Yes
No
If yes, specify the other pet(s)
(Required)
Any other reptiles?
(Required)
Yes
No
If yes, specify the other reptiles
(Required)
Reptiles are housed together or singly?
(Required)
Together
Singly
If not housed together, where are other reptiles located?
(Required)
Any new additions to the reptile population?
(Required)
Yes
No
If yes, please sepecify the new additions
(Required)
Additional Questions
Past Medical History/Problems
Current Presenting Problem
Duration of Complaint?
Email
This field is for validation purposes and should be left unchanged.
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