PRESCRIPTION REFILL
AFTER-HOURS EMERGENCIES
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Submit
New Patient Form - Exotics
Owner's Name *
Phone Number *
Email *
Pet's Name *
Birthday *
Sex *
Please Select
Male
Female
Unknown
Species *
Breed *
Tank type (glass, wood, etc.) *
Tank Size (W x L x H) *
Tank Temperature - Basking Side *
Tank Temperature - Hot Side *
Tank Temperature - Cool Side *
Tank Temperature - Night Time *
How is heat provided? (ie. lights, under tank heater) *
Is a UV light used? Provide brand name and frequency it is changed.
Humidity (are there more and less humid areas)? *
Substrate type *
Water dish provided: *
Is water treated, bottled or tap? *
Size of dish? *
Please list all food items offered (if commercial, list brand) *
What % of each food makes up diet (ex. 20% crickets, 50% pellets, 30% veggies). If insects are used, are they gut loaded & with what? *
Please list what supplements are used and how often *
Include brand & type (ie. Rep-cal calcium with D3)
Does your pet get bathed? *
If yes, how often & in what (ie. bath tub, rubbermaid)? *
Does your pet get outdoors? If yes, how often? *
When was the last shed? *
How often does your pet shed? *
How often is a full tank cleaning performed? *
WATER-BASED PETS
Filter type & capacity
Substrate (ie. rocks, sand, etc)
Ph Level:
Ammonia Levels:
How frequently is the water changed?
Is the water treated?
Are there live plants? If yes, what type?
Security Question *
I HAVE READ AND UNDERSTOOD THE
PRIVACY POLICY
*
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About Us
Our Team
Awards & Memberships
Careers
Pet Care
Bird Services
Cat Services
Dog Services
Exotic Pet Services
Healthy Start for Puppies and Kittens
Pocket Pet Services
Senior Wellness Health Checks
Online Store
Resources
Blog
Forms
Financing
Food Order Request
New Pet Owner Information
Other Links
Contact
REQUEST AN APPOINTMENT
PRESCRIPTION REFILL
AFTER-HOURS EMERGENCIES