Full Name
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First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Animal's name
*
Animal's species
*
Age
*
Sex
*
Regular veterinary clinic
*
Date acquired
Approximate
MM
DD
YYYY
Source
Store
Breeder
Adoption/rescue
Other
Please describe the issue in detail including the date it started (or when it was first noticed) and if any at-home treatments have been done and when.
*
Husbandry Information
*
Enclosure details including dimensions, type, and substrate type (describe bedding/flooring). Describe the enclosure with as much detail as possible (please also send photos to info@swiftailvet.com with the subject line "Photos for [pet's name]'s appointment").
Do you provide UV lighting?
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If yes, what strength? What form (T8, Mercury, T5Ho)? When was the last time you changed your UV bulb?
How many hours per day are the lights on? If avian, describe sleeping habits (covered, uncovered, sleeps in cage etc.).
What are the ambient and basking area temperatures (ºC)?
Do you measure temperature? If yes, how? Do you use a thermostat?
How do you provide ventilation in your enclosure?
*
Humidity control
*
How do you control humidity (e.g. automatic misting system)? If yes, for how long and how often is the enclosure being humidified? Do you measure humidity? Do you use a hygrostat?
What is the ambient humidity of the enclosure?
Please describe your enclosure maintenance
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e.g. Substrate replaced every __ weeks; deep clean every __ months
Main diet
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What do you feed? How often do you feed? For reptiles, if feeding mice or rats, are they live or pre-killed?
Supplements
*
Do you offer supplements? If yes, what do you offer? How often do you offer the above supplements? How long ago did you buy them? How do you store them?
Insects
Do you feed insects? What do you feed your insect feeders?
How do you provide enrichment?
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How often do you handle them? Are they tolerant of being handled if needing to medicate?
Have they been seen by a vet before? If so, please describe the nature of the visit.
Cohabitation
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Are they housed individually or do they cohabitate with other individuals? If yes, how many are in the same enclosure? Are males and females in the same enclosure? Do their enclosure mates have the same symptoms?
If female
Is it possible she may be pregnant/gravid (carrying eggs)? Note that even unbred females reptiles can lay infertile eggs. When was the last time she laid eggs/gave birth (if applicable)?
Hibernation
Do they hibernate/brumate? If so, when was their last hibernation? How long did it last or how long since it started?
Is there any other pertinent information you would like us to know?
Media permission (optional)
Would you allow Swiftail Vet to use the sumbitted photos and/or videos for educational purposes? These photos will be used to educate the public about common illnesses in pets, and spread awareness about pet health.
