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Hours 2752 W Lawrence Ave Suite 3
Chicago, IL 60625

Reptile Form

My name is:*

My reptile's name is:*

General Information

Is your reptile a pet or breeder?

Pet

Breeder

Where did you get your reptile?*

How long have you had your reptile?*

Health & Medications

Has your reptile seen a veterinarian before? **If so, please have records sent to animalhouseofchicago@yourvetdoc.com in advance or bring them to your appointment*

Does your reptile have any chronic health issues?*

Any history of egg laying?*

Any medications or supplements given (e.g. calcium)? *Please be as specific as possible.**

Enclosure

What kind of enclosure do you have? What material? What are the dimensions?*

What substrate is used? How often is it changed?*

Please list any cleaning agents used:*

What water source is used? *(E.g. bowl, tub, mist) If misted, how often?**

What accessories are in the enclosure? What material?*

If you use live plants, what kind?*

What is the humidity in the enclosure?*

What kind of heat source do you use? *(E.g. lamp, pad, etc.)**

Do you have a fill spectrum UVB bulb? If so, how often is it changed? What percentage is it?*

To the best of your knowledge, please list the temperatures of your reptile’s enclosure:

AM Temp:

Basking area:
Ambient area:

PM Temp:

Basking area:
Ambient area:

For Aquatic Reptiles:

Do you have a filter? If so, what kind? *(E.g. submersible, canister, hang-on)**

How often is the water changed?*

Do you use a water dechlorinator? If so, what brand?*

Feeding

Please list the quantity, brand, and type of each food source.

Pellets:
Fruits/Nuts:
Live Food:
Frozen Foods:
Other:

Any recent diet changes? If so, what did you change?*

Additional Information

Is there anything else you would like us to know about your reptile?*

Animal House of Chicago