Does your pet ever go outside? (required)
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Does your pet live primarily in a cage, terrarium, or other enclosed habitat? (required)
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If Yes, what are the dimensions of the cage/habitat?
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If No, or if your pet is ever allowed out of cage unsupervised, where does your pet live and/or play? (i.e. what rooms)?
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Where is the cage located? (required)
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Does your pet share a cage/habitat with any other pets? (required)
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Does your pet interact or live with other pets, outside of a cage (including supervised playtime)? (required)
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What bedding or substrate do you use in your pet’s habitat? (required)
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Are there any live plants in your pet’s habitat, or in areas of the home where your pet plays? (required)
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If Yes, what kind:
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Are the room(s) where your pet lives / where cage is located air conditioned? (required)
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Are the room(s) where your pet lives / where cage is located heated? (required)
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Do you use a full-spectrum UV light? (required)
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If Yes, please tell us how many watts:
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If Yes, please tell us type of bulb:
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If Yes, please tell us location relative to cage or habitat
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Do you use a heat source? (required)
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If Yes, please tell us the type of heat source (i.e. lamp, hot rock, etc.):
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Do you monitor the temperature in your pet’s habitat? (required)
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If Yes, typical high temperature (daytime):
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If Yes, typical low temperature (nighttime):
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Do you provide a temperature gradient (i.e. one part of habitat warmer, one part cooler) within the habitat? (required)
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Please tell us about anything else that is in your pet’s habitat:
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What does your pet eat? (Please be specific - i.e. “kale, romaine lettuce” not “greens” - and list everything the pet is fed, including treats.) (required)
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How often is your pet fed? (required)
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How much / how many? (required)
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Do you give a calcium supplement? (required)
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Do you give a multi-vitamin supplement? (required)
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Are vitamins put in the pet’s water? (required)
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Do you attend reptile shows? (required)
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If Yes, do you bring your pet?
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Patient Name: (required)
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Today's Date: (required)
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Appointment Date & Time (required)
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