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Amphibian History Form
When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.
Your Email Address
*
Your Full Name
*
Pet's Name (first and last)
*
Species
*
Age (if unknown please state UNK)
*
Sex
*
Sex
A
Male
B
Female
C
Unknown
How long have you had your pet and where did they come from?
*
Type and size of enclosure (ie. 20 gallon glass tank). If you have an unusual or
home made enclosure we encourage bringing pictures at the time of the
appointment to show the doctor!
*
What type of substrate is used and what type of cage furniture is in the enclosure?
How frequently is the enclosure cleaned and what disinfectant is used?
What type of lighting is used? How long do the lights stay on during the day? Please
include UV spectrum and when UV lighting was last changed if applicable.
What is used for heating of the enclosure?
Please list temperatures within the enclosure (if measured) in both the basking and
cool spots. If not measured please state "not measured".
What humidity level is the enclosure kept at. If not measured please state "not
measured."
What type of water is used?
What type of water is used?
A
City or Well Water
B
Bottled Water
C
Distilled Water
D
Reverse-osmosis
For city/well water, how is the chlorine removed?
For city/well water, how is the chlorine removed?
A
Aeration (aging)
B
Agitation
C
Activated charcoal or other filtration
D
Chemical treatments
How frequently is the water changed?
Is the water heated? If so, what temperatures is the water kept at?
I
s the water tested? If yes, please list most recent results.
If non-aquatic, how is water offered?
What type of food is fed? Please list in order of frequency, main portion of diet to
occ. treat.
Are you giving any supplements? If so, please list what form (liquid vs powder),
what brand and how frequently.
How often and how much are you feeding your pet?
When was the last time your pet ate?
Is your pet housed alone or with any other amphibians?
If housed with other amphibians, are there any new additions to the group?
Has your pet had any prior medical problems? If so, please elaborate
What is the reason for your pet being seen today? If sick, please include duration of
sickness.
Do you have any specific questions for the doctor regarding your pet? We look
forward to meeting your little friend!
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