Does your pet ever go outside? (required) No Yes, supervised playtime Yes, unsupervised playtime (includes time in cage/fenced area, if no human present) Yes, lives outside in good weather Yes, lives outside all yearDoes your pet live primarily in a cage, terrarium, or other enclosed habitat? (required) Yes NoIf Yes, what are the dimensions of the cage/habitat? If No, or if your pet is ever allowed out of cage unsupervised, where does your pet live and/or play? (i.e. what rooms)? Where is the cage located? (required) Does your pet share a cage/habitat with any other pets? (required) Yes NoDoes your pet interact or live with other pets, outside of a cage (including supervised playtime)? (required) Yes NoWhat bedding or substrate do you use in your pet’s habitat? (required) CareFresh, Kaytee SoftSorbent, CelSorb, Yesterday’s News, or other paper/pulp bedding Aspen shavings or pellets Pine or Cedar shavings or pellets Sand or fine gravel Bark or mulch-like substrate OtherAre there any live plants in your pet’s habitat, or in areas of the home where your pet plays? (required) Yes NoIf Yes, what kind: Are the room(s) where your pet lives / where cage is located air conditioned? (required) Yes NoAre the room(s) where your pet lives / where cage is located heated? (required) Yes NoDo you use a full-spectrum UV light? (required) Yes NoIf Yes, please tell us how many watts: If Yes, please tell us type of bulb: If Yes, please tell us location relative to cage or habitat Do you use a heat source? (required) Yes NoIf Yes, please tell us the type of heat source (i.e. lamp, hot rock, etc.): Do you monitor the temperature in your pet’s habitat? (required) Yes NoIf Yes, typical high temperature (daytime): If Yes, typical low temperature (nighttime): Do you provide a temperature gradient (i.e. one part of habitat warmer, one part cooler) within the habitat? (required) Yes NoPlease tell us about anything else that is in your pet’s habitat: What does your pet eat? (Please be specific - i.e. “kale, romaine lettuce” not “greens” - and list everything the pet is fed, including treats.) (required) How often is your pet fed? (required) How much / how many? (required) Do you give a calcium supplement? (required) Yes NoDo you give a multi-vitamin supplement? (required) Yes NoAre vitamins put in the pet’s water? (required) Yes NoDo you attend reptile shows? (required) Yes NoIf Yes, do you bring your pet? Yes NoPatient Name: (required) Today's Date: (required)
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Appointment Date & Time (required)
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