General Exotic Intake Form

Name*

First Last

Pet's Name*

Email*

Phone*

How long have you owned your pet?*

Where did you acquire your pet?*

How often is your pet handled?*

What type of habitat/enclosure does your pet have?*

What is the size of your pet's habitat/enclosure?*

Where is the habitat/enclosure located?*

Is your pet allowed to roam free in the house?*

Do you use any cage substrate (bedding)?*

If so, what kind?

If your pet is a mammal, do they use a litter box?

What type of furnishings are in your pet's habitat/enclosure? (Hides, Toys, Beds, Stones, Bowls, ect)*

How often is your pet's habitat/enclosure cleaned?*

What type of disinfectant is used?*

What is your pet's main diet?*

How often do you feed your pet and how much?

What other sources of food does your pet eat? (treats, fruits, vegetables, ect.)

How much and how often are these other food sources given?

Do you give your pet any supplements?*

If so, what kind of supplements?

What is your pets water source? (bowl, bottle, ect.)*

How often is your pet's water changed?*

Are there any other pets in your household?*

If so, do they interact?

What is the reason for your visit today?*

Does your pet have any previous medical problems?*