We look forward to seeing you at your upcoming appointment! Please complete the questionnaire below in advance. This will help with the accuracy of information and help to speed up the process!

• Upon arrival please come to the lobby to check in. Our lobby is open and we have coffee and snacks available! If you would like to wait in your car, we will give you a buzzer in order to notify you when we can see you.
• Please make sure to bring your reptile in an appropriate container with a heating element if necessary.

Wellness Exam Pre-Appointment Questionnaire – Reptiles

Owner's Name(Required)

First Last

Name of person attending appointment(Required)

First Last

Primary phone number to reach you with(Required)

Email(Required)

Pet's Name(Required)

First

Appointment Date(Required)

MM slash DD slash YYYY

Appointment Time(Required)

Hours

:

Minutes

AM PM AM/PM

Do you need an estimate for your appointment today?(Required)

Yes

No

If your pet has lab work, how would you like the results communicated to you?(Required)

Text Message

Email

Phone Call

How long have you had your reptile?(Required)

Age of your reptile.(Required)

Gender(Required)

Male

Female

Unsure

If female, has your reptile ever laid eggs?

Yes

No

If so, when?

MM slash DD slash YYYY

When was your reptile's last shed?(Required)

Month

Day

Year

Was it complete?(Required)

Yes

No

Unsure

How often does your pet soak?(Required)

More than 2 times per week

1-2 times per week

1 time every 2 weeks

Monthly

Only when having shedding issues

N/A – Aquatic reptile

Have you obtained any new reptiles in the last 6 months?(Required)

Yes

No

What type of enclosure does your reptile have?(Required)

Glass

Acrylic

PVC

High-density Polyethylene (HDPE)

Mesh

Other

What are the dimensions of the enclosure?(Required)

Where is the enclosure located in the house?(Required)

Are there any windows or vents near the enclosure?(Required)

Yes, it’s near a window.

Yes, it’s near a window and a vent.

Yes, it’s near a vent.

No, it is not near a window or vent.

What type of substrate do you use?(Required)

Sand

Coco husk

Paper

Astroturf

Sphagnum Moss

Cypress Mulch

Other

N/A Aquatic Reptile

How often is the substrate/enclosure cleaned or changed?(Required)

Please list all live plants in the enclosure.(Required)

What cleaning products do you use?(Required)

What toys or accessories are in the enclosure?(Required)

Are there any cage mites?(Required)

No

Yes

Unsure

How do you maintain humidity in the enclosure?(Required)

What is the humidity level in the enclosure?(Required)

What is the heat source (NOT light source) and where is it located?(Required)

How often does your pet receive direct sunlight? No screen, no window, nothing the sun has to travel through to get to your reptile.(Required)

How do you measure temperature in the enclosure?(Required)

Thermometer

Infrared

Combination

Other

How many temperature sensors do you have in the enclosure?(Required)

What is the temperature range in the cool section of your enclosure?(Required)

What is the temperature range in the warm section of your enclosure?(Required)

Is UVA and UVB lighting provided?(Required)

Yes

No

Unsure

Other

What type of bulbs do you use?(Required)

Strip bulbs

Can lighting

Mercury vapor

Unsure

Other

Is there a screen between the bulbs and the enclosure?(Required)

Yes

No

Unsure

Other

Approximately how many hours a day of lighting does your reptile receive?(Required)

How often are the lights changed?(Required)

When were the lights last changed?(Required)

MM slash DD slash YYYY

What do you feed your reptile? Please be very specific including amount, frequency, brands and occasional treats.(Required)

What medications/supplements is your pet on? Please be specific with brand names if possible, Calcium, Vitamin D3, Dusting, Garden, etc.(Required)

How do you provide water in the enclosure and how often is it changed?(Required)

Aquatic Species Only: How often is your water changed?

When was the last time a water quality test strip was used?

How often is your pet out of the water or dry docked?

Do you have any concerns or questions you would like addressed at your appointment? Please be as specific as you can.(Required)

Tell us a little bit about your pet's lifestyle! Time spent in and out of the enclosure, favorite activities, personality quirks, etc.(Required)

I understand that I assume financial responsibility for all services rendered, and that payment is due on the date of the appointment. The individual bringing my pet to the appointment is authorized to request services and communicate what my pet needs.(Required)