Reptile Husbandry Form
All information is strictly confidential. Please fill questionnaire to the best of your knowledge
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Your Full name *
Your Pet's name *
Species *
Your pets birthday *
Gender *
How long have you had them? *
Where was your pet acquired ? *
Required
How often is animal handled? *
When was the last shed?
Any trouble with shedding?
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Last fecal production?
Fecal consistency? Any changes? Please bring fresh specimen to appointment if possible.
Animal ever taken outside?
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Type and size of enclosure? Attach picture if possible. *
Frequency of enclosure cleaning? *
Type of disinfectant used to clean the enclosure? *
Where is the enclosure located ? *
Please describe enclosure furniture/ enrichment items?
What do you use of bedding / substrate ? *
Please list the folling information about the enclosure lights.
Name, brand and wavelength (if possible?)
 *
Heat Source? *
Humidity Level? *
Temperature within enclosure? 
Please list both the hot side and cool side temperatures.
 *
Type(s) of food offered? List all types. *
Amount fed/ Frequency? *
When was pet last fed? *
MM
/
DD
/
YYYY
Water source? *
Do you have any other pets? *
Do you have any other reptiles?  If so, please list below. *
How are reptiles housed? *
If not housed together, where are other reptiles located? Side by side? Same room? Different room?
Any new reptile additions to the household? *
Any past medical history / problems? Please forward any previous medical records to staff@crossroadsahc.com. *
Previous tests or treatments for parasites?
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Current presenting problem? How can we help you? *
Duration of complaint? *
Any other questions or concerns?
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