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Reptile/Amphibian Husbandry Form

"*" indicates required fields

Your Name*

First

Last

Phone*

Email*

Address

Address Line 1

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Pet Information

Pet's Name

Pet’s Species*

Pet’s Age*

Pet sex (If known)*

Male

Female

Where did you get your pet?

How long have you had your pet?

Do you own any other reptiles/amphibians?*

Yes

If yes, what kind?

Enclosure type*

Dimensions (LxWxH)

Cage furniture

Substrate

How often is the enclosure cleaned?

What do you use to clean the enclosure?

Describe your method of heating

How is heating measured?

How is humidity measured

What lighting do you use?

Is there UVB?

How often do you replace the bulb?

What time cycle is your lighting?

Does your pet get any natural sunlight?*

What do you feed your pet (include frequency)?*

What supplements do you feed your pet?*

How do you provide water?

Do you soak your pet? If so, how often?

Last shed and quality (if applicable)

For aquatic animals only

How do you measure your water quality? pH, ammonia, temperature, nitrates, nitrites, etc:

How often do you check the quality of your water?

What type of filtration system do you use?

Please upload images of your pet's enclosure- allow client to attach image

Drop files here or

Max. file size: 50 MB.

Signature*

Date*

Comments

This field is for validation purposes and should be left unchanged.