 info@exoticpetclinic.com  831-440-8590.. . . .

Home
Current Clients
New Clients
About Us
Services
Forms
Resources
Contact
Appointment

We have Rabbit Hemorrhagic Disease vaccines in stock!

Please note: We will be closed Thursday 11/28 and Friday 11/29 for Thanksgiving!

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

We're excited to meet you!

Call Us

Questions?

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



Contact

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

}

Hours

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



Location

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

Name *

First

Last

Email *

Phone *

Phone Type *

Mobile
Landline

How can we help you? *

Comment

© 2024 Exotic Pet Clinic of Santa Cruz | Powered by WhiskerCloud

Translate »