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(908) 359-2000
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10 Sunset Road | Belle Mead, NJ

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Vet Services
Meet the Team
- Our Veterinarians
- Our Staff
Current Clients
First-Time Clients

Reptile & Amphibian Patient Form

To aid the doctor in reaching an accurate diagnoses, a complete background on your reptile is essential. Please fill out all of the following patient data to the best of your ability.

Reptile & Amphibian Patient Form

Where was the pet obtained?

Sex

Male

Female

How was sex determined?

How long have you owned this pet?

HOUSING ENVIRONMENT

Size and type of cage

Cage bottom substrate

How often is the caged cleaned?

What do you use to clean?

Location of the pet's housing

Cage temperature

How is it measured?

Is there a heat source?

Yes

No

Type of heat source

Cage humidity

How is it measured?

Type and brand of UV light

How often is the bulb changed?

Any natural sunlight?

Yes

No

Light control timer

Automatic

Manual

Duration of light hours

Duration of dark hours

Does your pet soak?

Yes

No

How often?

When was the last soak?

Type/Source of water

Is your pet free to roam?

Yes

No

How often?

Other types of reptiles?

Yes

No

What kinds?

How long have they been in the household?

Direct contact or share a cage?

Yes

No

Any other pets? (Please list)

Changes to pet's environment in last 6 months?

Yes

No

Environment changes?

Moving homes

Changed cage

Loss of people/pets

Travel

Out of the house in the last year?

Yes

No

Where?

Contact with other reptiles (out of house)?

Yes

No

DIET

Describe diet (types, amounts, frequency, live, pre-killed, preyed, offered)

Supplements?

Yes

No

List supplements

Last time fed/ate?

HISTORY

How often does your pet shed (reptiles)?

Any difficulty?

Yes

No

Please describe

Examined by another veterinarian?

Yes

No

Injuries, illness or surgeries?

Yes

No

Describe injuries, illness or surgeries

On medication?

Yes

No

List medication

Adverse reactions?

Other symptoms?

Cough

Sneeze

Runny nose

Runny eyes

Vomiting

Abdominal droppings

Behaviour

Changes in appetite

Describe other problems

When did you first notice?

Has it gotten worse?

Yes

No

Explain how it became worse

Administered any medications or treatments?

Yes

No

List oral medications

List food/water

List injections

List topical medications

Did the treatments help?

Yes

No

How did the treatments help?

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(908) 359-2000
Mon-Thurs: 7:30am - 7pm
Fri: 7:30am - 6pm
Sat: 8:00am - 1pm
10 Sunset Road
Belle Mead, NJ, 08502

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