618-750-PETS(7387)
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Reptile & Amphibian History Form

Save time during your appointment. Complete your required forms online from any device at any time before your visit.

Reptile & Amphibian History Form

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

Date

Animal Information:

Time Owned:

Primary Care Giver: *

First

Last

Email *

Source: *

Captive Bred
Wild Caught
Unknown

Other Pets; Note most recent addition:

Owner or pets in contact with other Reptiles? *

Quarantine procedure?:

Housing:

Cage Dimensions:

Made of:

Type:

Arboreal
Terrestrial
Aquatic
Thermostat Control

Heat Sources:

Thermometer

Yes
No

Thermometer type

Digital
Sticker
Plastic Dial
Temp Gun

Day Temp (Range):

Night Temp (Range):

Hygrometer:

Yes
No

% Humidity:

Multiple Choice

Spray
Mist
Dripper
Bathe

Frequency:

UV light source:

Yes
No

Brand/Strength:

Age of Bulb:

Distance of bulb from animal:

Photoperiod:

Cage top:

Secured?

Yes
No

Additional Ventilation:

Shared Enclosure:

Yes
No

Substrate:

Sub. Depth:

Haul Out:

Yes
No

Filters (Type, Size)

Depth of Water:

Water change:

Partial
Full

Water Testing?:

Live Plant/Types:

Cleaning Regime:

Spot Clean
Full Clean

Disinfectant Used:

Cage furniture:

Cage location:

On or near speakers or windows?:

Location of other reptile(s):

Frequency Handling/Time out of Enclosure:

Ever Outside:

Yes
No

Diet

Prey Type:

Multiple Choice

Dead
Live
Frozen

Color of last meal(rodents)?

Is this the usual color?:

If Live, How long left in enclosure?:

Frequency of feeding Prey:

Frequency of feeding salad:

Supplement Type/Brand/Freq:

Gut loading? How?:

Veggies/Type:

Fruit/Type:

Commercial Food Used:

Yes
No

Brand:

%Fed:

Ever feed Wild-caught food?

Yes
No

Water Source:

Frequency of cleaning?

Large enough for soaking:

Yes
No

General

Reproductive Status:

Last Clutch Laid:

How Many?:

Last Shed:

Complete:

Yes
No

Last Defecation:

Normal?

Yes
No

Last Fed:

Previous Health Problems?

On-going meds:

Ready to Visit?

We Know Pets Are Family

Let us show you how we can make veterinary visits less stressful, more engaging for the entire family, and fear-free. We are here to help with your pet throughout your journey together.

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Questions?

Get in touch! We look forward to hearing from you.

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Location

2533A Vandalia St.
Suite B
Collinsville, IL 62234

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Contact Information

Email: hello@villagevetpet.com
Phone: 618-750-PETS (7387)

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Hours

Monday – Friday: 8:30 am – 5:30 pm

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First

Last

Email *

Phone

How can we help you? *

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We Proudly Serve the Pets of the Collinsville, IL Area, and Surrounding Towns in the MetroEast Area

Maryville, IL
Glen Carbon, IL
Edwardsville, IL
Troy, IL
Alton, IL
Godfrey, IL

O'Fallon, IL
Marine, IL
St. Jacob, IL
Highland, IL
MetroEast St. Louis

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