Name: Macungie Animal Hospital
Address: 161 East Main St, Macungie, PA, 18062, US
Telephone: (610) 421-8381
Price range: $$

Reptile History Form

Owner's Name*
First Last
Your Pet’s Information
Name*
Species Or Common Name
Date of Birth or Age (if known)*
Origin*
- Captive Bred
- Wild Caught
- Unknown
Sex*
Neuter/Spayed?*
- Yes
- No
- Unknown
How long have you had your pet?
From where did you obtain your pet?
Do you have other pets or reptiles in the household?*
- Yes
- No
Enclosure Details
Hottest (basking) temperature*
Coolest temperature*
Are these temperature measured using a thermometer?*
- Yes
- No
Do you measure humidity in the cage?*
- Yes
- No
What type of cage is used?*
- Arboreal (tall, climbing)
- Terrestrial
- Aquatic
What is the cage made of?*
- Plastic
- Wooden
- Metal
- Glass
What is in the cage set up (décor, toys, ventilation, etc)? Substrate?*
Are bathing facilities/bowls provided?*
- Yes
- No
How often do you clean the cage and what do you clean it with?*
What heating equipment is used (ceramic, bulb, water heater, rock, etc)?
Can reptile touch or access the heat source?*
- Yes
- No
Does your reptile have exposure to sunlight (Not through glass or plastic)?*
- Yes
- No
Does your pet have exposure to UVA and UVB lighting?
- Yes
- No
What percentage of the time does your pet spend in the cage?*
Is your pet supervised when out of the cage?*
- Yes
- No
Have there been any changes in the environment in the last 3 months?*
- Yes
- No
Diet Details
How often do you feed your pet?*
Please select which foods are eaten:*
- Vegetables
- Fruits
- Flowers
- Insects
- Rodents
- Other
Are the prey fed?
- Live
- Freshly Killed
- Frozen/Thawed
- Wild Caught
- N/A
Do you use any nutritional supplements in food or water?*
- Yes
- No
Water Details
What water supply do you provide?*
- City Tap Water
- Bottled Water
- Well Water
How is water provided?*
- Bowl
- Dripper System
- Sprayed
How often is the water changed?*
Reason for Visit today
What is the primary reason why you brought your pet in to see veterinarian today?
Have you noticed any changes in feeding or drinking behavior?*
- Yes
- No
Have you noticed any changes in droppings?*
- Yes
- No
Has your pet had any previous health problems OR reproductive problems?*
- Yes
- No
When was your pet’s last shed?*
How often has your pet been shedding?*
Have any other animals or people in your household had any illness within the last 30 days?*
- Yes
- No
What are your pet’s current medications? Has your pet received any medications or treatments in the last 3 months (what was used, dosage, how often and duration):
File
Drop files here or

Shop From Home

Online Pharmacy

Have a Question? Need to book an appointment?

Connect with us and one of our team members will be happy to assist you.

Contact

161 East Main St.,
Macungie, PA 18062

(610) 421-8381
portal@macungieanimalhospital.com

Get Directions

Hours

Monday & Thursday:
8:00 AM – 7:00 PM
Tuesday, Wednesday, Friday:
8:00 AM – 6:00 PM
Saturday:
8:00 AM – 2:00 PM

Reptile History Form

Your Pet’s Information

Enclosure Details

Diet Details

Water Details