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reptile lifestyle Assessment

Please click the button below to fill out the form.

reptile lifestyle

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Reptile Lifestyle Assessment

Please fill out the form as completely and as accurately as possible, thank you.

Name *

First

Last

Email *

Pet's Name *

Species

Date of Birth (or suspected age)

Sex

Male
Female
Unknown

How long have you had this pet?

Cage dimensions?

Is this cage shared with any other pets?

Cage construction and materials (please check all that apply)

Glass(aguarium, teraarium)
Wood
Plastic
Screen
Other

Cage contents (please check all that apply)

Hide box
Rock
Live plants
Plastic plants
Humid hide/ hut
Other

What substrate do you use on the bottom of the cage?

Soil
Shavings. wood chips
Newspaper
Sand
Paper Towels
Other

How often is the cage cleaned?

How often is the cage disinfected?

Disinfectant used?

Please list all food items and their approximate percentage of total diet

Frequency of feeding

Daily, every other day etc

Do you gut load insects before feeding?

Yes
No

Please list any dietary supplements(calcium, multivitamin, etc) used

Enclosed Temperature Range

How is temperature measured?

Gauge type & Location

Do you decrease the temperature for seasonal hibernation? If yes, please describe

Heating Method (please check all that apply)

Heat bulb
Heating pad/tape
Heat rock
Radiant Heat Panel
Other

Total hours of light each day:

Lighting method

Filtered sun (through window)
Direct sun light
Room light
UVA/UVB near light
UVA/UVB spot light
Flourescent/Incandescent bulb (No UVB)

Humidity percentage and how it's measured:

Is a humid hide used? (area of high humidity)

Yes
No

How is water offered? (please check all that apply)

Bowl
Spray/mist
Rain or drip system
Other

Date of last fecal examination:

Any parasites identified?

Yes
No

Date of last shed

Please describe any past illnesses

Any new reptiles/ have they been sick?

Ready to see us?

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Address

14605 E. Arapahoe Rd. Unit H.
Aurora, CO 80016

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Contact Info

E: lovingfamilyanimalhospital@gmail.com
P: 303-680-5050
F: 303-680-5550

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Hours

M, W, F: 8 am – 6 pm
Tues, Thurs: 8 am – 6 pm
Sat: 9 am – 1 pm
Sun: Closed

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First

Last

Email *

Phone

How can we help you? *

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