Online Form

Reptile History Questionnaire

Complete your reptile history form online from any device at any time before your visit.

Reptile History Questionnaire

Please fill out this form as completely and accurately as possible so we can get to know you and your pets before your visit.

"*" indicates required fields

Client Name:*

First Last

Patient Name:*

Date:*

MM slash DD slash YYYY

Please be sure to fill this questionnaire out to the best of your ability and bring it along with you to your appointment.

Background Information

How long have you had your pet?*

Where was your pet acquired?*

Breeder

Pet Store

Other

If other please explain:*

Was your pet:*

Wild-Caught

Captive Bred

Has your pet been de-parasitized?*

Yes

If yes, with what?*

How often is your pet handled?*

Daily

Occasionally

Never

Do you ever take your pet outside?*

Yes

If yes, for how long?

When was your pet's last shed?*

Does he/she have any trouble shedding?*

Yes

If yes, please explain:*

What has your pet's fecal consistently been like?*

Do you have any other pets?

Yes

If yes, what species/breed?*

If other reptiles, are they housed together?*

Yes

If other reptiles, Yes*

Husbandry

What type of enclosure do you have for your pet?*

What size is it?*

Where is it located?*

Do you have any furniture in the enclosure?*

Yes

If yes, please explain:*

What substrate do you use in your pet's enclosure?*

How often is your pet's enclosure cleaned?*

What products do you use?*

Enclosure Environment

What type of lighting is your pet exposed to?*

UVB

Incandescent

Other

If other, please describe:*

How many hours of light does your pet get per day?*

What type of heat source is provided for your pet?*

Heat Bulb

Heat Rock

Under Tank

Other

If other, please describe:*

What is the humidity level in your pet's enclosure?*

Please list the temperatures of each area in your pet's enclosure:

Nutrition

What type and brand of food do you offer your pet?*

How much food do you feed your pet?*

How often is your pet fed?*

What type of water source is provided for your pet?*

Do you provide any supplements?*

Yes

If yes, please list them and their dosing instructions:*

Questions/Concerns

Please feel free to list any questions or concerns you may have about your pet that you would like to discuss during your appointment.

Comments

This field is for validation purposes and should be left unchanged.

Have A Question?

Please use the information below to contact us. A member of our team will be in touch soon!

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Contact

P: (610) 948-1014
E: contact@royersfordvet.com

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Location

850 Main St. Royersford, PA 19468
Our parking lot is located off 9th Street.

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Opening Hours

Mon & Wed : 8.00 am – 6.00 pm
Tues & Thurs: 8.00 am – 7.00 pm
Fri: 8.00 am – 5.00 pm
Sat: 8.00 am -12.00 pm

Name *

First

Last

Email *

Phone

How can we help you? *

Website