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.

OPTION 1
Fill Out Online

Complete the online form below and submit.

OPTION 2
Print & Complete

Once completed, bring the form with you.

Download Form

OPTION 3
Complete in Office

If you prefer, you can fill out the form when you arrive at our hospital.

New Patient Form - Reptiles

Please provide us with the following information.

Important: If your pet is an avian or exotic patient, please also download and complete the reptile questionnaire.

First Name *

Last Name *

Phone *

Email *

What is the best way to reach you? *

How did you hear about us? *

If Other, Please Provide Details

If Vet Referral, Provide Name of Vet

About Your Reptile

Pet's Name *

Species *

Breed or Morph *

Sex (Gender) *

Do you know the date of hatch? *

Date of Hatch (If Known)

Date Pet was Obtained *

Pet's Age When Obtained *

Was your pet captive bred or wild caught? *

Place Pet was Obtained *

Name of Pet Store, Breeder, or Rehoming Organization

Enclosure

Enclosure Location in Home *

Location Details (if Other)

Enclosure Type (Choose All that Apply) *

What are the enclosures dimensions? (Include Height, Width, and Depth) *

Enclosure Substrate *

Enclosure Substrate (if Other)

Furniture Provided in Enclosure (Branches, Logs)

Hide Box (Terrestrial Species)

Daytime Temperature Range (From - To)

Nighttime Temperature Range (From - To) *

Basking Temperature *

Thermometers *

Ultraviolet Light

Details of Ultraviolet Light (Source, Distance, Frequency Changed)

Other Lighting (Describe)

Photoperiod (Provide # Daylight Hours, # Dark Hours)

Water Source *

Water Filter (Aquatic Species)

How often is water filter changed?

Relative Humidity % (If No Hygrometer Used Enter Unknown)

Water Spraying or Soaking

Details of Water Spraying or Soaking (if Yes)

Diet & Suppliments

Formulated Diets (Please Provide All Brands and Details of Products)

Frequency of Formulated Diets Being Offered *

Prey Items Provided (Carnivorous Species)

None

Pinkie Mice

Fuzzy Mice

Hopper Mice

Adult Mice

Small Rats

Adult Rats

Other (Please Provide Details Below)

Form of Prey Offered

Frequency of Prey Offered

Number Per Feeding

Feeder Insects *

None

Crickets

Mealworms

Superworms

Waxworms

Hornworms

Butterworms

Dubia Roaches

Silkworms

Flies

Other (Please Provide Details Below)

Feeder Insect Details (if Other)

Frequency Feeder Insects Are Offered *

Number Per Feeding

Green Leafy Vegetables Provided *

None

Kale

Collards

Spinach

Parsley

Green or Red Lettuce

Iceberg Lettuce

Mustard Greens

Turnip Greens

Chard

Dandelion Greens

Cabbage

Bok Choi

Broccoli

Watercress

Dandelion

Carrot Tops

Other (Please Provide Details Below)

Green Vegetables Provided (if Other)

Frequency That Green Leafy Vegetables are Offered

Other Vegetables Provided *

None

Carrots

Sweet Potatoes

Cauliflower

Beets

Squash

Zucchini

Other (Please Provide Details Below)

Vegetables Offered (if Other)

Frequency That Other Vegetables are Offered

Fruits Offered *

None

Strawberries

Bananas

Grapes

Papaya

Mango

Apple

Citrus Fruits

Blueberries

Other (Please Provide Details Below)

Fruits Offered (if Other)

Frequency of Fruits Offered *

Supplements Given (Check All That Apply) *

None

Calcium-Only Powder or Spray (Please Provide Amount and Frequency Details Below)

Calcium-D3 Powder or Spray (Please Provide Amount and Frequency Details Below)

Other (Please Provide Details Below)

Amount & Frequency of Supplements Provided

Feeding Schedule *

When was your reptile last fed? *

When was the last time your reptile ate? *

Environment & Previous Medical History

Any cage mates? If yes, please describe. *

If yes, are cage mates healthy?

Are there other pets in the home? If yes, please describe *

Has your pet had previous wellness examinations? If yes, please describe. *

Has your pet had a previous adverse drug reaction? *

Date of Last Shed

Was it a complete shed?

Any recent egg laying? (Females only) If yes, please describe.

Any previous medical or surgical problems? If yes, please describe.

Check if your pet has, or has had, any symptoms in the following areas to a significant degree. If any, please provide details below.

Skin

Scales

Toenails

Head or Neck

Lips or Oral Cavity

Throat

Nasal Passages

Airways or Lungs

Feces

Urine or Urates

Legs or Feet

Behavior

Recent changes in body weight

Recent changes in energy level or activity level

Recent changes in thirst

Recent changes in appetite

Recent changes in breathing rate, effort, or pattern

Current Problem (If Appointment is for Medical Concern)

When was the problem first detected? Please Provide Date

Please describe the problem.

How has the problem changed?

Current Medication and Response (if Any)

Additional Question or Concerns You May Have About This Pet

Upload Files or Images

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

Upload File

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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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Happy Tails from Clients

"I truly could not recommend CVS enough, from the moment we walked in the door with an emergency situation the compassion and care that both we and our hedgehog Hershey received was wonderful from every single staff member and doctor we encountered."
- Sarah H.

New Patient Form - Reptiles

OPTION 1
Fill Out Online

OPTION 2
Print & Complete

OPTION 3
Complete in Office

New Patient Form - Reptiles

About Your Reptile

Enclosure

Diet & Suppliments

Environment & Previous Medical History

Current Problem (If Appointment is for Medical Concern)

Upload Files or Images

Salmonella Advisory Warning

Caring for Pets in Huntersville

Important Information For Clients Regarding COVID-19 Virus. Click Here

New Patient Form - Reptiles

OPTION 1Fill Out Online

OPTION 2Print & Complete

OPTION 3Complete in Office

New Patient Form - Reptiles

About Your Reptile

Enclosure

Diet & Suppliments

Environment & Previous Medical History

Current Problem (If Appointment is for Medical Concern)

Upload Files or Images

Salmonella Advisory Warning

Caring for Pets in Huntersville

Important Information For Clients Regarding COVID-19 Virus. Click Here

OPTION 1
Fill Out Online

OPTION 2
Print & Complete

OPTION 3
Complete in Office