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Reptile History Form
Your full name
*
Primary phone number
*
Pet's name
*
Length of time owned:
*
Sex:
*
Sex:
A
Male
B
Female
C
Unknown
Neutered or Spayed?
*
Neutered or Spayed?
A
Yes
B
No
C
Unknown
Has the animal ever laid egg/given birth?
*
Has the animal ever laid egg/given birth?
A
Yes
B
No
C
Unknown
Where was the animal acquired?
*
Where was the animal acquired?
A
Breeder
B
Pet Store
C
Rescue
D
Other
Origin:
*
Origin:
A
Captive
B
Wild-Caught
C
Unknown
How often do you handle your reptile?
*
How often do you handle your reptile?
A
Daily
B
Occasionally
C
Never
Do you take them outdoors?
*
Do you take them outdoors?
Daily
Occasionally
Never
Do you have any other reptiles at home?
*
Do you have any other reptiles at home?
A
Yes
B
No
Have you added other reptiles to your collection?
*
Have you added other reptiles to your collection?
A
Yes
B
No
Have you had contact with reptiles outside your home in the last 30 days?
*
Have you had contact with reptiles outside your home in the last 30 days?
A
Yes
B
No
Do you own other animals (birds,dogs,cats, etc)?
*
Do you own other animals (birds,dogs,cats, etc)?
A
Yes
B
No
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