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We have Rabbit Hemorrhagic Disease vaccines in stock!

History Form

This history form is for lizards and turtles.

Lizard and Turtle History Form

Please fill out the following form as thoroughly as possible. Please note: All * fields are required.

Owner's Name *

First

Last

Phone *

Email *

Date *

Pet's Name *

General Information

How long have you owned your pet? *

How old is it? *

What species of reptile do you have? *

Major Colors

Do you know if it is male or female? *

Do you have any other reptiles as pets? *

Housing

How big is the cage? *

What is it made of? *

What bedding is used? *

How often is the cage cleaned? *

What cage furnishings are available (e.g. rocks, hide box, branches, etc)? *

Is water available in the cage? *

Yes
No

What heat source(s) do you use? *

Do you have a thermometer in the cage? *

Yes
No

What is the temperature range during the day? *

What is the temperature range during night? *

Do you provide your pet with ultraviolet (UVB) light? *

Yes
No

When was the bulb last replaced? *

Changed within the past month
2-5 months
6-8 months
9-12 months
Over a year

Do you have a probe to measure humidity levels in the cage? *

Yes
No

What is the humidity value?

Feeding

What food items are being offered? *

How often is your pet being fed? *

Is the food offered in a separate cage? *

Do you add a calcium supplement to your pet’s food? *

Yes
No

If yes, how often? *

Does it contain vitamin D3? *

Do you add a multivitamin supplement to your pet's food? *

Yes
No

If yes, how often? *

Previous Veterinary Care

Has your pet received veterinary care at another clinic? If so, please tell us the name of the clinic.

Has your pet had previous medical problems? *

Your Visit to Our Clinic

Is your pet sick? *

Yes
No

If yes, what are the symptoms? *

How long has it been sick? *

Are any of your other pets also ill? *

Have you tried any treatments? *

Is there anything else we can help you with?

I would like diet information
I would like husbandry information
I have a question about... (specify below)

What question(s) do you have? *

Contact Us

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Questions?

Contact us with the information below or fill out our online form.

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Contact

E: info@exoticpetclinic.com
P: 831-440-8590

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Hours

Mon - Fri: 8:30 am to 6:00 pm
Sat - Sun: Closed

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Location

5400 Scotts Valley Drive, Suite B
Scotts Valley, CA 95066

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Email *

Phone *

Phone Type *

Mobile
Landline

How can we help you? *

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