Reptile History Form – Moray Coast Vet Group

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Health Plan
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Contact/Opening Hours

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Reptile History Form

Pet Name/ID *

Species *

In present owner's care since *

Colour *

Date of birth/age *

Sex *

Male
Female
Unknown

Where did you obtain this animal? *

Breeder
Pet Shop
Importer
Other (please specify below)

Other:

Environment *

Type of Enclosure *

Arboreal
Terrestrial
Aquatic

Environment *

Temperate
Tropical
Desert

Size of longest side of enclosure: *

Size of shortest side of enclosure: *

Height of enclosure: *

Construction materials: *

Paint/Varnish: *

Interior fittings: *

Sealant: *

Purchased ready made *

Yes
No

Substrate used: *

Temperature Daytime Range *

Temperature Night-time Range *

Basking Temperature *

Humidity level Daytime *

Humidity level Night-time *

Humidity - Method Provision *

Spray
Sprinkler
Water Bowl

Lighting Equipment: *

Spot Light
Light Bulb
Fluorescent Strip Light

UVB Light Provision (brand) *

UVB Light - when was it last renewed? *

UVB Light - day length? *

UVB Light - distance from basking area *

DIET/SUPPLEMENTS *

Amount of food normally offered *

Amount eaten *

Frequency of feeding *

Method of providing drinking water *

Bowl
Spray
Other (please spefify)

please specify other method of providing water

How often is the water changed daily (12hrs)

Selected Value: 1

Vitamin/mineral supplements *

Please state what supplements? How are they offered? And how often they are offered?

History - What signs prompted you to bring in this animal? *

History - Have any other animals been sharing the vivarium in the last 6 months? *

History - Please let us know of any other animals housed in the same room or visiting the room in the last 6 months *

History - Please list any disease history of this animal *

History - Please list the disease history of any in-contact animal(s) *

History - Please give any other details that may be relevant *

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