Lizard Dental and Health

Patient information

Name:*

Species*

Bearded dragon
Leopard gecko
Other

Sex*

Male
Female
Unknown

Age*

How long have you owned this pet?*

Where did you get your pet?*

Breeder
Pet store
Rescue
Other

Habitat & Enclosure

Tank size*

20 gallon
40 gallon
75+ gallon
Other

Enclosure type:*

Glass tank
PVC Enclosure
Other

If you clicked "other", please elaborate:

Substrate used*

Tile
Reptile carpet
Paper towels
Sand
Other

If you clicked "other", please elaborate:

How often is the enclosure cleaned?*

Daily
Weekly
Monthly

Lighting & Temperature

Do you provide UVB lighting?*

Yes
No

If yes, what brand/type?*

T5 HO
T8
Coil/compact
Other

If you clicked "other", please elaborate

How old is the bulb?*

How many hours per day is UVB on?*

How old is the bulb?*

How many hours per day is UVB on?*

How far is the bulb from the basking spot?*

Do you provide a basking light?*

Yes
No

Type of heat source?*

Halogen bulb
Ceramic heat emitter
Other

If you clicked "other", please elaborate:

How long is the basking light on?*

Temperature in basking spot (*F):*

Temperature on cool side (*F):*

Temperature at nighttime (*F)*

How do you measure temperatures?*

Digital thermometer
Temp gun
Stick-on thermometer

Diet & Nutrition:

What type of vegetables do you feed?*

What type of fruits do you feed?*

What types of proteins do you feed? Insects/worms? How frequent?*

How often do you offer food?*

Daily
Every other day
Few times per week

Do you dust the food with supplements?*

Yes
No

Calcium?*

with D3
without D3
Both
No

How frequently do they receive calcium?*

Do they receive multivitamins?*

Yes
No

How often do they receive multivitamins?*

Do you gut-load insects?*

Yes
No

What water source is provided?*

Dish in tank
Misting
Baths
Other

If you clicked "other" please elaborate:

Behavior & Health

Have you noticed any of the following issues?*

If you clicked "other", please elaborate:

Has your lizard every laid eggs?*

Yes
No
N/A

Any past illnesses or medical concerns?*

Any recent changes in behavior?*

Additional information

Do you have any questions/concerns/notes about your lizard's health or care?

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History Form: Lizard

Patient information

Habitat & Enclosure

Lighting & Temperature

Diet & Nutrition:

Behavior & Health

Additional information