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Call: 978-632-7110
Text: 978-632-7110
73 Eaton Street Gardner, MA 01440

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Reptile Information Form

Please complete the form below to submit the Reptile Information Form online. You can also click the button below to download and print the form.

Owner’s Name *

First

Last

Email *

Pet’s name *

Species *

Sex *

Male
Female

How was sex determined? *

Length of ownership *

Quarantine period *

Where did you obtain pet? *

REASON FOR PRESENTATION TODAY

Size and type of cage *

How often is the cage cleaned? *

What cleaner(s) do you use? *

Where is the cage located within your home? *

Temperatures *

Cool
Warm
Basking

How are they measured? *

What type of heat source are you using? *

What is the cage's humidity? *

How is that measured? *

What do you use for light source? *

Do you have a broad spectrum (UVB/UVA) bulb? *

Yes
No

How often is it changed? *

Light cycle *

Manual
Timer

Duration hours of light *

Duration hours of dark *

Substrate (material on the bottom of the cage) *

What objects are in the cage? *

How often do you soak? *

When was the last soak *

Does your pet spend time outside of enclosure? *

Yes
No

Is it supervised? *

Yes
No

Any other reptiles in the house? *

Yes
No

List types and how long you have had them and where they are in relation to the pet *

Other pets

Any changes in the past 6 months?

Move
Cage change
Travel
Loss of People or Pets

Has your pet left the house in the past year? *

Yes
No

If so, where? *

Any contact with reptiles outside the home? *

Yes
No

If so, where? *

Diet

Please describe your pet’s diet. (Include types, amounts, frequency, live vs killed prey items, etc.) *

Do you offer any supplements, vitamins or water additives? *

Yes
No

Type, amount & frequency of administration *

Last time you fed? *

Last time your pet ate? *

History

Frequency of shed *

Last shed? *

Any issues with shedding? *

Yes
No

Describe *

Has your pet been examined by another vet? *

Yes
No

When? *

Any injuries, illnesses or surgeries? *

Yes
No

Describe *

Have any been seasonal? *

Currently on any medications? *

Yes
No

List *

Any adverse reactions to any medications? *

Yes
No

Describe *

Have you noticed any of the following clinical signs at home? (please check any that are applicable) *

Cough
Sneeze
Runny Nose
Runny Eyes
Behavioral Change
Change in Appetite or Thirst
Vomiting/Regurgitation
Other

If other, explain *

Please share any additional concerns or information you feel is pertinent to your pet’s care: *

Ready for a visit?

We deliver veterinary care with respect and compassion to the pets of Gardner, Westminster, Ashburnham, Templeton, and beyond. Easily request an appointment for your pet using our online system on PetDesk and keep up with your pet’s health by downloading our app!

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Have a question?

Complete the form below and a member of our team will get back to you as quickly as possible.

Name *

First

Last

E-mail *

Phone

I consent to receive SMS text messages from Gardner Animal Care Center. Msg & data rates may apply. Reply STOP to opt-out. *

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How may we help you? *

Comment

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Where to Find Us

73 Eaton Street
Gardner, MA 01440

Click here for directions.

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How to Reach Us

Call: 978-632-7110

Text: 978-632-7110

Fax: 978-632-7354
Email: [email protected]

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Our Hours

Mon – Fri: 8:00 am – 7:00 pm
Sat: 8:00 am – 2:00 pm
Sun: Closed

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