Reptile Care Questionnaire

Animal Hospital of Warwick

2370 York Road, Commonwydds A-1
Jamison, PA 18929

(215)343-5300

www.animalhospitalofwarwick.com

Reptile Care Questionnaire


  

Reptile Care Questionnaire Form

Does your pet ever go outside? (required)

No
Yes, supervised playtime
Yes, unsupervised playtime (includes time in cage/fenced area, if no human present)
Yes, lives outside in good weather
Yes, lives outside all year


Does your pet live primarily in a cage, terrarium, or other enclosed habitat? (required)

Yes
No


If Yes, what are the dimensions of the cage/habitat?

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)?

Where is the cage located? (required)

Does your pet share a cage/habitat with any other pets? (required)

Yes
No


Does your pet interact or live with other pets, outside of a cage (including supervised playtime)? (required)

Yes
No


What bedding or substrate do you use in your pet’s habitat? (required)

CareFresh, Kaytee SoftSorbent, CelSorb, Yesterday’s News, or other paper/pulp bedding
Aspen shavings or pellets
Pine or Cedar shavings or pellets
Sand or fine gravel
Bark or mulch-like substrate
Other


Are there any live plants in your pet’s habitat, or in areas of the home where your pet plays? (required)

Yes
No


If Yes, what kind:

Are the room(s) where your pet lives / where cage is located air conditioned? (required)

Yes
No


Are the room(s) where your pet lives / where cage is located heated? (required)

Yes
No


Do you use a full-spectrum UV light? (required)

Yes
No


If Yes, please tell us how many watts:

If Yes, please tell us type of bulb:

If Yes, please tell us location relative to cage or habitat

Do you use a heat source? (required)

Yes
No


If Yes, please tell us the type of heat source (i.e. lamp, hot rock, etc.):

Do you monitor the temperature in your pet’s habitat? (required)

Yes
No


If Yes, typical high temperature (daytime):

If Yes, typical low temperature (nighttime):

Do you provide a temperature gradient (i.e. one part of habitat warmer, one part cooler) within the habitat? (required)

Yes
No


Please tell us about anything else that is in your pet’s habitat:

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)

How often is your pet fed? (required)

How much / how many? (required)

Do you give a calcium supplement? (required)

Yes
No


Do you give a multi-vitamin supplement? (required)

Yes
No


Are vitamins put in the pet’s water? (required)

Yes
No


Do you attend reptile shows? (required)

Yes
No


If Yes, do you bring your pet?

Yes
No


Patient Name: (required)

Today's Date: (required) :
Client Name: (required)
First Name (required)
Last Name (required)
Appointment Date & Time (required) :

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