Online Forms

Reptile & Amphibian History Form

Reptile & Amphibian History

Thank you for choosing Creekside Veterinary Hospital! Please fill out this form as accurately as possible if you would like to discuss weight loss at your appointment, or if you’ve been asked to by a CVH employee..

Date

Animal Information:

Time Owned:

Primary Care Giver: *

First

Last

Email *

Source: *

Captive Bred
Wild Caught
Unknown

Other Pets; Note most recent addition:

Owner or pets in contact with other Reptiles? *

Quarantine procedure?:

Housing:

Cage Dimensions:

Made of:

Type:

Arboreal
Terrestrial
Aquatic
Thermostat Control

Heat Sources:

Thermometer

Thermometer type

Digital
Sticker
Plastic Dial
Temp Gun

Day Temp (Range):

Night Temp (Range):

Hygrometer:

% Humidity:

Multiple Choice

Spray
Mist
Dripper
Bathe

Frequency:

UV light source:

Brand/Strength:

Age of Bulb:

Distance of bulb from animal:

Photoperiod:

Cage top:

Secured?

Additional Ventilation:

Shared Enclosure:

Substrate:

Sub. Depth:

Haul Out:

Filters (Type, Size)

Depth of Water:

Water change:

Partial
Full

Water Testing?:

Live Plant/Types:

Cleaning Regime:

Spot Clean
Full Clean

Disinfectant Used:

Cage furniture:

Cage location:

On or near speakers or windows?:

Location of other reptile(s):

Frequency Handling/Time out of Enclosure:

Ever Outside:

Diet

Prey Type:

Multiple Choice

Dead
Live
Frozen

Color of last meal(rodents)?

Is this the usual color?:

If Live, How long left in enclosure?:

Frequency of feeding Prey:

Frequency of feeding salad:

Supplement Type/Brand/Freq:

Gut loading? How?:

Veggies/Type:

Fruit/Type:

Commercial Food Used:

Brand:

%Fed:

Ever feed Wild-caught food?

Water Source:

Frequency of cleaning?

Large enough for soaking:

General

Reproductive Status:

Last Clutch Laid:

How Many?:

Last Shed:

Complete:

Last Defecation:

Normal?

Last Fed:

Previous Health Problems?

On-going meds:

Ready to visit?

we know that pets are family.

We believe you deserve compassion, integrity, and collaboration with each step of your pet’s life. Come meet us! We can’t wait to help you and your pet.

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

Address

2987 Hunting Dr. NW, Cleveland, TN 37312



Contact

E: [email protected]
P: 423-709-7979
T: 423-799-2937



Hours

Mon: 8 am – 6 pm
Tue: 8 am – 6 pm
Wed: 8 am – 1 pm
Thu: 8 am – 6 pm
Fri: 8 am- 6 pm

** Our hours are set to expand! As soon as we can grow to add more employees and doctors, we will be offering even more hours for your convenience and for your pet’s urgent needs! **

Name *

First

Last

Email *

Phone

How can we help you? *

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