Reptile Questionnaire

Patients' Names:

Your Full Name*:

Email*:

Contact Number*:

Your pet's species*:

Length of time owned*:

Pre-ownership History*:

What is your pets normal feeding regime?*:

When did your pet last eat normally?*:

When did your pet last eat and what did they eat?*:

Any supplements provided to pet (what, when and how provided?)*:

When were faeces last passed? Were they normal? (Please bring a recent faecal to your appointment)*:

Has your pet had any previous disease testing or faecal testing?*:

What is your pets normal activity level?*:

What is your pets normal demeanour and temperament?*:

What is he/she like now?*:

What type of enclosure is he/she housed in?*:

What are the humidity levels in the enclosure*:

If you would like to upload a photo of the enclosure, please do so:

What is the substrate used?*:

How often is the enclosure cleaned?*:

Is he/she housed solitary?*:

Yes
No

If not solitary, how are the others in the collection?:

If not solitary, does he/she have direct access to any others in collection?:

Do you have any new animals in the collection (when acquired, source)?:

Does your pet have outside access (proportion of time spent outside)?*:

When did he/she last shed and were there any problems with previous sheds?*:

Do you have UV provisions?*:

Yes
No

If yes, what UV provision do you have and when was bulb last changed?:

Do you have heat provisions?:

If yes, what heat sources are available?:

If yes, when did you last check the temperatures and what were they?:

Hot end.................. Cool end............. Temperature measurement method.........

What is your main concern today?*:

Have you given your pet any medications/treatment? (what and when?):

Security Question*: