Amphibian Husbandry Form Please fill out our Amphibian Husbandry Form provided below. If you need help or have any questions, please call us at (215) 995-4049. Amphibian Husbandry Form Amphibian Husbandry Form Date * Pet's Name * Species * Client Name * Client Name First Name First Name Last Name Last Name Email * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal We regularly post photos of our patients to our social media, both for education and for fun! Do you give us permission to post photos of your pet? Yes No How did you hear about our clinic? Is your pet protected by an insurance plan? Is this a referral? Regular DVM/Hospital? Habitat and Enclosure Type of Habitat Terrestrial Aquatic Semi-aquatic Arboreal OtherOther Enclosure Type Glass tank Plastic enclosure Screened terrarium Naturalistic vivarium OtherOther Enclosure Size (L x W x H) Number of Amphibians Housed Are they the same species? Yes No If mixed species, list all Substrate Used Coconut fiber Sphagnum moss Soil mix Paper towels Gravel Bare bottom OtherOther Cleaning Frequency Daily Weekly Bi-weekly Monthly Rarely Environmental Conditions Humidity Range (%) Misted manually Automatic misting system Fogger used Water bowl only Temperature Range (Day/Night) Heater Heat mat Ceramic heat emitter No heating used Lighting Used Natural daylight UVB bulb LED light Full-spectrum bulb Duration per day UVB bulb brand/type (if used) Water Source (if aquatic or semi-aquatic) Tap Dechlorinated tap RO/DI Bottled Rainwater OtherOther Water Change Frequency Daily Weekly As needed Water parameters tested? Yes No If yes, list Feeding & Nutrition Diet Provided Crickets Dubia roaches Mealworms Earthworms Bloodworms Fruit flies Fish OtherOther Feeding Frequency Daily Every other day Few times a week Weekly OtherOther Specify type of fish Supplements Used Calcium (with D3 / without D3) Multivitamin None Frequency of supplementation Behavior & Health Normal Activity Level / Behavior Active at night Hides frequently Vocalizes Basking Swims regularly OtherOther Recent changes in behavior? Yes No If yes, describe Health Concerns Observed Not eating Lethargy Weight loss Skin shedding issues Bloating Skin lesions or discoloration Floating or abnormal swimming OtherOther Previous Medical Issues or Treatments? Yes No If yes, explain Additional Information Do you quarantine new amphibians before introducing them? Yes No Duration Where do you usually get your husbandry information? Online forums Breeders Books Vets OtherOther Any specific questions or concerns for the veterinarian today? Owner's Signature * signature keyboard Clear Submit If you are human, leave this field blank.
