Health Risk Assessment - Reptile
Hello! Please help us expedite your check-in process, decrease your wait time, and offer you the best medical care during your Preventative Healthcare Plan Exam, Annual Examination, or Complete Physical Exam, by completing this history form prior to your appointment. You can complete it by yourself, with other family members or in the office, but with a little advance planning we can help lead your attending DVM to develop the best plan for your pet's ongoing healthcare.
Email address *
First & Last Name of Pet Owner *
Your answer
Pet Reptile's Name *
Your answer
Updated Contact Information
If you have moved within the last year, or if your phone number or primary email address has changed, please let us know so we can update your records.
Your answer
Does Your Pet Have A Photo On File? *
If you know your pet's photo has been updated, please select "Yes." If you would like to submit a new photo, please send your photo online to, or we we'll be happy to take a picture with a fresh look for your on the day of your appointment.
How did you obtain your pet reptile?
If your reptile was caught in the wild:
Please state the country and circumstance under which your reptile was obtained
Your answer
Length of Relationship With Your Reptile?
How long have you known the reptile, and how long have you owned him/her?
Your answer
This Reptile's Primary "Person" *
Who is the person, or who are the people who primarily interact with and handle this particular reptile? Please indicate if any of these persons listed are under the age of 18, and if all responsible parties will be present during the appointment.
Your answer
Handling by People *
Handling by People
If your reptile is handled, please describe the average amount of time your reptile spends being handled someone per day/week/monthly etc., and your handling preferences for this reptile
Your answer
Time out of Enclosure/Reptile Schedule
Please describe the average amount of time, if any, that your reptile spends outside of his/her enclosure(s) per day/week etc. or a typical day for your reptile. If your reptile does not leave the enclosure, simply type "N/A"
Your answer
Is Your Reptile Deparasitized?
Please select "yes," "no" and if "yes" check the last box and describe the medication you used and the last time you used it. If you do not remember the name, state "unknown", but list the date you believed he/she was deparasitized.
Soaking/Nail Clipping
Please state if or when your reptile has had access to soaking or misting (if species appropriate), what water source or facilities are typically used for this activity. If your pet is a reptile which benefits from nail clippings, please describe your preferences. All sorts of people have all sorts of experiences with their reptiles--if you are not sure about anything you can say "unknown," or feel free to ask questions in the final section about care.
Your answer
Current Medications/Supplements *
If your pet is taking any prescription medications, or OTC medications, please list the type and dosage below. For example, if your pet is receiving a medication but you aren't sure of the exact dosage, you can read the label and type how much you have been instructed to give - dosage on file. If your pet was prescribed medication previously, but no longer takes the medication, or if the dosage has been adjusted by a veterinarian or at home, you may comment below as well. If you received medication from a breeder please include the information here. If your pet takes no medications, simply comment "None" or "N/A"
Your answer
Refills Needed?
If you listed prescription medications, vitamins or supplements in the space above, you may request a refill or for a script to be renewed below. Please indicate the medication or prescription diet you would like to refill, and the amount you would like to have renewed or refilled.
Your answer
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