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Reptile History/Husbandry Worksheet

Please answer the following questions as accurately as possible. Problems relating to improper housing and feeding are common among pet reptiles. Your answers will help us recommend any changes that may influence your pet’s health. We will also provide you with a list of our recommendations to consider

Date

First Name

Last Name

Pet Name

Pet Birthdate

Pet Sex

Pet Species

Pet Breed

General Information

How long have you had this reptile?

Approximately how old was this reptile when acquired?

Approximately how big was this reptile when acquired?

Where did you obtain your reptile?

Where did you obtain your reptile?
A
B
C
D

Is it:

Is it:
A
B
C

This animal is a

This animal is a
A
B

Have you noticed any reproductive behavior?

Have you noticed any reproductive behavior?
A
B

Has this reptile had any reproductive issues in the past? Has it been “spayed” (salpingohysterectomy)?

Has this reptile had any reproductive issues in the past? Has it been “spayed” (salpingohysterectomy)?
A
B

When did your reptile last shed?

Has it had any issues shedding now or in the past?

Has it had any issues shedding now or in the past?
A
B
Housing Information

Optional

Optional
A
B
C
D
E
F
G
H

What is on the bottom of the cage?

What is on the bottom of the cage?
A
B
C
D
E
F
G

How often is the cage cleaned?

How often is the cage cleaned?
A
B
C

What do you use to clean/disinfect the enclosure?

What is the temperature range in your enclosure?

Basking site (°F)

Daytime High (°F)_______ Low (°F)______

Nighttime High (°F)_______ Low (°F)______

How is the temperature measured?

How is the temperature measured?
A
B
C

How do you keep the cage warm?

How do you keep the cage warm?
A
B
C
D

Describe any humidity sources

Do you measure humidity?

Do you measure humidity?
A
B

What is the humidity level?

Do you have additional light, ie: UVB? What is this?

How often do you replace this light?

How often do you replace this light?
A
B
C
D

What barriers are between the light and your reptile?

What barriers are between the light and your reptile?
A
B
C

Does your reptile have access to unfiltered natural light? If yes, how often and how long?

Is your reptile cooled for hibernation?

Is your reptile cooled for hibernation?
A
B

Has your reptile’s environment changed recently? If yes, please describe

Is your reptile kept alone? Please describe cage mates

Diet Information

When did your reptile last eat?

What do you feed your reptile?

What do you feed your reptile?
A
B
C
D
E
F
G
H
I

How often do you feed this reptile?

How much do you feed at a time?

What do you feed (gutload) the insect prey items?

What do you feed (gutload) the insect prey items?
A
B
C
D
E

Do you use any vitamin or mineral supplements? What kind? How often?

How do you provide water to your reptile?

How do you provide water to your reptile?
A
B
C
D
Medical Information

What is the primary reason for your visit today?

How long have you noticed the problem that prompted today’s visit? ie: when did you first notice the problem?

Does your reptile have any history of illness or injury? Please Decsribe

Has your reptile been seen by another veterinarian?

Has your reptile been seen by another veterinarian?
A
B

Is the problem getting:

Is the problem getting:
A
B
C

Have you noticed any of the following signs? (check all that apply)

Have you noticed any of the following signs? (check all that apply)

Is your reptile currently taking any medications? If yes, please list:

Have you tried over the counter supplements or remedies? If yes, please list:

Has any member of your household been sick in the past month?

Has any member of your household been sick in the past month?
A
B

Are you aware that any reptile may carry Salmonella bacteria?

Are you aware that any reptile may carry Salmonella bacteria?
A
B