Aquatic Turtles New Patient Form

"*" indicates required fields

Client Information

Name*

First

Last

Phone*

History

Pet's Name*

Species*

Age*

Sex*

Male

Female

Unknown

How do you know your pet's gender?*

Where did you get your pet?*

When did you get your pet?*

Has your pet been to a vet before?*

Yes

Where?

Any prior medical concerns?

Do you have any medical records?

Is your pet on any medications?*

Yes

Please list medications

Habitat

What kind of habitat do they live in?*

Where in the home is it located?

What size is the habitat?*

What is the top covered with?*

Is there any kind of substrate?*

How often is it cleaned, and with what?*

How much water is available for swimming?*

What is the water source (ex: bottled, tap, etc)?*

How often is it changed, what percent each time?*

Is there a filter system?*

Yes

What kind of filter system? (ie canister filter vs biofilter)

How many gallons is it rated for?

Any water additives / dechlorinators used?*

Is there access to a dry basking area?*

Yes

Basking temperature?

What is in the enclosure with your pet?*

Hides? Plants (real or artificial)? Other “furniture” or decorations?

What type of light source(s) are used?*

UVA? UVB?

How often is it replaced?*

Where is lighting positioned?*

What time is it turned on/off?*

What type of heat source is used?*

Is there a lamp?*

Yes

Does the lamp also provide light?

Yes

How often is it replaced?

Where is it positioned?

Is there an underwater heater?*

Yes

What barrier is between the heater and the pet?

Is the heat source ever turned off for any amount of time?*

What is the typical water temperature?*

How is the temperature monitored?*

Diet

Do you feed in enclosure or in a separate feeding tank?*

What is being fed?

Live Prey

Veggies

Pellets / Commercial Diet

Anything else?

Type, amound and frequency

Any supplements? (Ex: Calcium, multivitamin, etc)*

Yes

Type, amount and frequency of each?

How is it provided?

Enrichment

Does your pet spend time outside of their habitat?*

Yes

How often and for how long?

Inside or outside?

Are they ever allowed to roam unsupervised?

Does your pet interact with any other animals? What kind?*

Is your pet routinely handled and by who?*

Signature*

Date*

Comments

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