Reptile Information Form in Laporte, CO

lnformation on Reptile
Type of reptile
Name
Age
Sex (if know
How long have you owned the reptile?
From where did you obtain this reptile?
Description (markings, scars,etc.)
Diet
Prey food
Vegetables (type & amount)
Fruit (type & amount)
Formulated Diet
Habitat
Heat source: Daytime
Heat source: Nighttime
Do you have a thermometer?
What temperature is the cage?
Do you have a heat rock?
Ultraviolet bulb?
Time of day bulb is on
How old is the bulb
Date of other examinations or procedures
Pertinent Medical History
Have you recently had any other reptiles come in contact with this one?
lf yes, what species, how long ago, and were they ill?
Is this reptile housed with any other reptiles?
Reason for visit today
To keep medical expenses to a minimum, we are unable to extend credit. How do you wish to pay for you professional services?
- Cash
- Check
- Credit Card

Reptile Information Form