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: *

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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 *

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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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