Exotic Pet Care History Form

Fill out our exotic pet care history form below!

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Exotic Pet Care History Form

Please fill out the form below as completely and as accurately as possible.

Client Information

Name *

First

Last

Phone Number on Account *

Address on Account *

Address Line 1

Address Line 2

City

State

Zip Code

Patient Information

Pet's Name *

Species *

Age (if known)

Sex *

Husbandry Information

Enclosure Size and Type

Enclosure Population

Water Sources # and Type

Heat Sources Type and Location

Enclosure Temperature

Enclosure Humidity %

Substrate/Bedding Type

Last time changed UV bulb

Diet Information

Diet Type

Diet Schedule (how much and how often)

Any live feeds (insects, mice, etc)?

Any foraged feeds (outdoor plants, etc)?

Any table scraps?

Supplements

How is feeding done (dish, tongs, etc)?

Exotic Pet Safety Agreement

I understand and agree to keep my exotic pet safely contained for the duration of the appointment — from check-in through check-out — unless my pet is actively being examined by a team member. Approved containment includes an appropriate carrier, secured box, enclosed tank, or properly fitted harness with leash. I understand that failure to follow these safety guidelines may result in the appointment being rescheduled. These standards are in place to protect the safety of your pet, our team, and other patients, as we are a mixed-animal practice. Thank you for helping us create a safe and comfortable environment for everyone. *

I understand and agree

New Clients & New Patients

If you or your pet are new to our practice, please complete our New Client Form prior to your appointment. To ensure we always have the most accurate and up-to-date information, you may be asked to review or complete this form at future visits as well.

We appreciate your cooperation and look forward to caring for your pet!

Client Signature *

Clear Signature

Name *

Date *

Pet Name(s) *

Message

Exotic Pet Care History Form

Exotic Pet Care History Form

Client Information

Patient Information

Husbandry Information

Diet Information

Exotic Pet Safety Agreement

New Clients & New Patients

Request an Appointment with Us

Request an Appointment with Us

Location

Contact Information

Hours

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