Veterinary Forms | Cedars Veterinary Hospital

Pet Name*

Species/Breed*

Age/DOB*

Sex*

Male

Female

Unknown

How long have you owned your pet?*

Where were they acquired?*

Store

Breeder

Other

List other pets in home*

Are any reptiles housed together? If so, how many/what species?*

What type of cage is pet housed in (include dimensions)?*

Where is enclosure located in house?*

Substrate*

Type of substrate used
How often is it changed?
How often is cage cleaned/with what cleaning chemicals?

Heating*

Heat source
Average day temp
Average night temp
Basking temp

Lighting*

Light source
Is there UVA/UVB light present?
How long is light kept on?
When was light source last changed?

Water*

Water source (bowl, dripper, etc)
How often is water changed?

Other cage accesories*

Is pet ever allowed run of house or allowed outdoors?*

Diet information*

List items fed
How much are they fed?
How often?
Are insects pre-fed commercial diet?
Is calcium/multivitamin supplemented?
Calcium/multivitamin products used
How often?

Any previous issues*

Any current problems*

Has your pet ever been seen by another veterinarian?*

Yes

No

If yes, when and why?

Any previous treatments/deworming?*

Have you noticed any of the following?*

Diarrhea

Bleeding

Blindness

Difficulty breathing

Vomiting

Lameness

Sneezing

Constipation

Weight loss

Change in appetite

Change in stool

Excessive water intake

Other

Have any other reptiles in the house been sick/expired in the last year?*

Yes

No

N/A

Reptile History Form

Pet Name*

Species/Breed*

Age/DOB*

Sex*

How long have you owned your pet?*

Where were they acquired?*

List other pets in home*

Housing

Are any reptiles housed together? If so, how many/what species?*

What type of cage is pet housed in (include dimensions)?*

Where is enclosure located in house?*

Substrate*

Heating*

Lighting*

Water*

Other cage accesories*

Is pet ever allowed run of house or allowed outdoors?*

Diet

Diet information*

Past Medical History

Any previous issues*

Any current problems*

Has your pet ever been seen by another veterinarian?*

If yes, when and why?

Any previous treatments/deworming?*

Have you noticed any of the following?*

Have any other reptiles in the house been sick/expired in the last year?*

If yes, how many have been sick/expired?

If known, from what disease?