Amphibian History Form – Wrights' Vets

Client Name *

First Line of Address *

Telephone Number *

Pet Name *

Species *

Age *

Sex *

Male
Female
Unknown

Has this been confirmed by sexing? *

If your pet is female, has she produced eggs or given birth?

How did you acquire your pet? *

Store
Breeder
Other

Please give details *

Are there any other pets in the same enclosure with this pet? *

What weight is your pet? *

How long is your pet? *

Is your pet microchipped? *

Housing

General

What enclosure/system do you keep your pet in (i.e. vivarium, tank, tortoise table, stack, free roaming)? *

What are the dimensions of your pet's enclosure? *

What is it made of (wooden, glass fronted, all glass etc)? *

Where is it positioned in the room (near radiator / window etc)? *

What substrate is used in the enclosure (sand, newspaper, etc)? *

How deep is it? *

Are hides provided? *

If so what bedding is used? *

How often is the enclosure cleaned, and with what products? *

Please upload a photograph of the enclosure

Click or drag a file to this area to upload.

Please upload individual files with the following extensions: .png, .jpg, .jpeg, .doc, .docx, .pdf

Housing continued

Heat

What heat sources are provided? *

Are heat sources protected? And if so how? *

Enclosure temperatures:

Layout

Day high/low *

Basking site temperature *

Night high/low *

Are these temperatures thermostatically controlled? *

Are additional thermometers used? If so are they constant or used periodically? How often? *

Housing continued

Humidity

Percentage humidity in enclosure *

How is humidity provided? *

How is humidity measured in the enclosure? How often? *

Percentage humidity in hide *

Do you mist the enclosure and how often? *

UV

Is there a UVB or full spectrum light source? *

How many hours/day?

When was it last changed? *

How far away from the pet is it positioned? *

Is it inside or outside the enclosure? *

Water

How deep is the water? *

Is a dry area provided? Of what size? *

What is the temperature of the water? *

Do you have a filter or aerator? *

How often do you change the water?

Partial *

Full *

When was the water last changed? *

Do you add anything to the water when it is changed? If so what? *

Diet

What Does Your Pet Eat?

How often is your pet fed? *

When did your pet last eat? *

What do you normally feed your pet? (please be as specific as you can – greens, fruit, veg, meat sources inc insects and how often each is provided) *

If insects are fed, are they gut loaded before being fed to your pet? *

If so, with what product(s)?

What kinds of supplements / vitamins do you give your pet and how often do you give them? *

Does your pet get treats, and what kind? *

How is water offered (bowl, dropper, etc)? *

Do you soak your pet, how often and how long for? *

Medical History

Do you routinely give your pet any medication? If so what and how often? *

Does your pet have any previous/underlying medical conditions that you know of? *

What do you believe the current problem is? Signs, duration, no of animals affected *