New Patient Form - Reptiles

If your pet is a reptile and a new patient at Carolina Veterinary Specialists in Huntersville, please fill out our New Reptile Patient form using one of the options below.

New Patient Form - Reptiles

Please provide us with the following information. 

 Important:  If you are a new client to Carolina Veterinary Specialists, please also complete a New Client Registration Form - Avian & Exotics. 

Client first name *

Client last name *

Primary phone number *

Please indicate if this is a cell phone, home, or work number. *

Cell phone Home phone Work phone

Is it okay to text you at this number or leave voice mail messages? *

Email *

About Your Reptile

Pet's name *

Species *

Breed or morph

Sex (Gender) *

Female Male Unknown

Date of hatch

Date pet was obtained

Place reptile was obtained. Please state the name of the pet store, breeder, or rehoming organization (if known). *

Enclosure

Please describe your reptile’s enclosure. Please include caging materials and approximate dimensions of your reptile’s primary enclosure. Please include details on cage substrate or liner, branches, hide boxes, and other furniture. *

Do you use thermometers to track the temperatures in your reptile’s enclosure? If so, for terrestrial reptiles, what are the following temperatures – Nighttime temperature, daytime cool side temperature, daytime warm side temperature, and basking temperature? For aquatic reptiles, what is the water temperature and basking temperature? *

Please describe the lighting in your reptile’s enclosure, including photoperiod (number of hours of light per day). Please also include details on ultraviolet B (UVB) lighting (if provided), including manufacturer of UVB bulb(s), distance to the reptile, and bulb changing frequency. *

For terrestrial reptiles, please describe the source of drinking water and bathing or misting frequency. Is the humidity in your reptile’s enclosure measured? If so, what is the relative humidity? For aquatic reptiles, please describe water filtration and temperature regulation. *

Diet and Supplements

Please describe the diet plan for your reptile here. Please include brand names for any commercially produced diets (eg. pellets). Please describe the amount offered and frequency of each food item and how much is eaten. Please indicate if invertebrate food items are dusted or gut-loaded. *

When was the last time your reptile was last fed? When did it last eat?” *

Please describe any supplements you provide for your reptile here, including vitamin and mineral dusts or sprays. *

Environment and Enrichment

Are there any cage mates? If so, please describe. Are the cage mates healthy? *

Are there any other pets in the home? If so, please describe. *

Is your reptile taken outdoors? If so, please describe. *

Medical History

Has your reptile had previous preventative health care visits to a veterinarian? If so, please describe. *

When did your reptile last shed, and was it a complete shed?

(Females only) – Any recent egg laying or nesting behavior? If yes, please describe.

Reason For Visit

What is the reason for your visit? *

Initial wellness exam Referral from another veterinarian Medical concern (non-referral) Behavioral concern (non-referral) Same-day emergency (non-referral)

If here for a medical or behavioral concern, please describe. Please include when the problem was first noticed, how it has changed, treatments used, and response to treatment.

If your reptile is currently on any medications or supplemental therapies, please provide details here, including any adverse drug reactions.

Are there any special requests for handling your reptile today?

Please describe any additional questions or concerns you may have about your reptile.

Upload Files or Images

Please attach any previous medical records and files, or images of enclosure, home, food, droppings, pet, etc.

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Salmonella Advisory Warning

Most, if not all, reptiles carry salmonella bacteria in their intestinal tract and intermittently or continuously shed these bacteria in their feces. Salmonella bacteria usually do not cause any illness in reptiles, but can cause serious illnesses in people.

Salmonella bacteria are easily spread from reptiles to humans. Humans may become
infected when they place their hands on objects, including food items, that have been in contact with the stool of reptiles, in their mouths.

Please refer to the ARAV at
http://arav.org/salmonella-bacteria-reptiles/ or the CDC at https://www.cdc.gov/features/salmonellafrogturtle/index.html for further information.

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