Name *

Email *

Please describe the main reason for bringing your pet in for an exam. Include any observed symptoms or changes in behavior that you’ve noticed. *

Have you attempted any treatments or interventions for your pet’s condition? *

Yes
No

Please provide details about the treatments, their duration, and their impact on your pet’s condition. *

Are there any past health concerns or diagnoses that your pet has experienced? This could include any chronic conditions, surgeries, or ongoing medications your pet has received. Please provide as much information as possible. *

Pet Information

Sex *

Age *

Species *

History

Where did you get your pet?

How long have you had them? *

Have you ever had your pet sexed? *

Ownership

How long have you had your pet? *

Does your pet have a reproductive history? *

Yes
No

Shedding

How often does your pet shed? *

Any difficulty with shedding? *

Yes
No

Health and Contact

Contact with other reptiles/amphibians in the last 30 days? *

Yes
No

Any change in your pet’s behavior? *

Yes
No

If yes, please provide details *

Have any other animals or people at home been ill in the last 30 days? *

Yes
No

Habitat

Cage type, material, and size *

Decor and furnishings (hide boxes, branches, etc)

Substrate type *

Cage ventilation (grills/mesh) *

Habitat Location

Cage location *

Percentage of time in/out of cage *

Heating and Lighting

Heating equipment and schedule *

Temperature range (warm/cool sides) *

UV lighting presence, distance, and replacement frequency *

Humidity and Environment

Cage humidity measurement and level *

Day and night temperatures (hottest/coolest areas) *

Recent environmental changes *

Household Factors

Feeding frequency and location *

Types and amounts of foods (insects, vegetables, rodents, etc) *

Insect gut loading *

Yes
No

Special Care

Nutritional supplements (type, amount, frequency) *

Water supply (type, method, frequency) *

Warm water soaks frequency *

Health and Observation

Changes in fecal material, urine, urates *

Other

Smoking in the household: *

Use of aerosolized products *

You are welcome to take photos of your pet’s cage setup, foods, medications and supplements. You can then choose from the following options:

1. Bring the questionnaire and photos to the appointment: you can bring the completed questionnaire and the photos with you to the appointment. Our veterinary team will review them during the examination.

2. Email the questionnaire and photos: If you prefer, you can email the completed questionnaire and the photos to us at frontdeskhpmc@gmail.com. Please send the email at your soonest convenience, preferably before the appointment. Our team will review the information to ensure we have a comprehensive understanding of your pet’s care before the visit.

Thank you!

We appreciate your cooperation in providing us with this valuable information, as it will assist us in delivering the best possible care to your beloved pet. If you have any questions or need further assistance, feel free to contact us at
205-772-3288.

Reptile Mammals Exotic Questionnaire

Reptile Exotic Questionnaire