Reptile Pre-Examination

Species*
Pet's Name*
Where did you acquire your pet?*
How long have you owned your pet?*
What do you feed your reptile (percentage if multiple items)? What is actually consumed?*
Do you use a vitamin supplement?
- Yes
- No
If you use a vitamin supplement, what type do you use and how often?*
Do you have a heat source?
- Yes
- No
If you have a heat source, what type do you have?*
Do you have a light source?
- Yes
- No
If you have a light source, what type do you have and when was it last changed?*
Is there a temperature monitor in the enclosure?
- Yes
- No
Is there a humidity monitor in the enclosure?
- Yes
- No
What is the highest temperature in the enclosure?*
What is the lowest temperature in the enclosure?*
What is the humidity level?*
How do you maintain the humidity? Natural, Misters, Dripper system, etc.?*
What type of enclosure do you have for your reptile?*
How big is the enclosure?*
What substrate do you have on the bottom of the enclosure?*
What cage decorations are in the enclosure?*
Please list any previous medical problems or past concerns.*