Aquatic Husbandry Form Please fill out our Aquatic Husbandry Form provided below. If you need help or have any questions, please call us at (215) 995-4049. Aquatic Husbandry Form Aquatic Husbandry Form Date * Pet 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- I give permission NO- please do not post my pet on social media 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 Enclosure Aquarium (Glass) Pond Plastic Tank OtherOther Tank Size (in gallons or liters) Number of aquatic animals in the tank Species housed together Filtration System in Use None Sponge Filter Hang-on-back Canister Internal OtherOther Water Changes Frequency Daily Weekly Bi-weekly Monthly Rarely Water Testing Conducted? Yes No If yes, list parameters tested (e.g., pH, ammonia, nitrites, nitrates) Water Quality & Conditions Average Water Temperature Heater used Chiller used Room temperature only Water Source Tap RO/DI (Reverse Osmosis/Deionized) Well Bottled Rainwater Water Conditioner or Additives Used Yes No If yes, list Lighting Used Natural only LED Fluorescent UVB (if reptile/amphibian) Duration per day Feeding & Nutrition Diet Provided Commercial Pellets/Flakes Live Food Frozen Food Fresh Veggies OtherOther Feeding Frequency Once daily Twice daily Every other day Weekly OtherOther Specify Type Specify Type Supplementation (e.g., vitamins, calcium): Yes No If yes, specify Behavior & Health Normal Behavior Observed Any recent changes in behavior? Yes No If yes, describe Any signs of illness or injury? Lethargy Not eating Fin/tail damage Buoyancy issues Skin lesions Color change Gasping at surface OtherOther Previous medical issues or treatments? Yes No If yes, describe Additional Information Do you quarantine new arrivals? Yes No If yes, how long? Do you consult forums/groups for care information? Yes (list sources)Yes (list sources) No Any concerns or questions for the veterinarian today? Owner's Signature * signature keyboard Clear Submit If you are human, leave this field blank.
