Step 1 of 333%CommentsThis field is for validation purposes and should be left unchanged.(This form helps us to get a better understanding of how your turtle is cared for at home and must be filled PRIOR TO the appointment)Name(Required) Prefix First Last Suffix Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email(Required) What is your turtle’s name?(Required)What type of turtle do you have?(Required)What is the birth date or estimated age of your turtle?(Required)Gender?(Required) Male Male/Neutered Female Female/Spayed UnsurePrior vet/clinic information(Required)What are the symptoms of concern for your pet and when did you first notice?(Required)Have you done any home remedies or treatments for your concerns? If so, please list what and how often you've done this.(Required)Has your turtle had any previous medical concerns?(Required)Is your turtle on any current medications? If so please list what medications he is on.(Required)Is your turtle microchipped?(Required) Yes NoHow long have you had your turtle and where did you get it from?(Required)The next few questions relate to the enclosure, could you please describe the enclosure’s size? For example 4 feet long x 2 feet wide x 4 feet high. If possible please also take a photo of your enclosure and email it to us, or bring it with you to your appointment (on your phone is fine).How is the enclosure heated? What is the temperature and humidity ranges? Please include day time and night time ranges.(Required)What is the enclosure size (dimensions) and location in the house?What type of UV light is provided and when was this last changed?(Required)What type of substrate is used on the enclosure?(Required)How do you clean the enclosure and how frequently?(Required)Do you keep any other types of reptiles or animals in the same enclosure?(Required) Yes NoDo you keep other reptiles in different enclosures? If so please provide a brief list.(Required)What do you feed your turtle and how often?(Required)Do you gut-load the insects?(Required) Yes NoDo you provide any supplements in the diet?(Required) Yes NoIf yes, please provide the name, description, and how often you give the supplement.When did your turtle/tortoise last defecate? Please bring a fresh sample of this to your appointment.(Required)Does your turtle have constant access to water? If so, how is it provided?(Required)Do you have a semi-aquatic turtle? Yes NoSemi Aquatic TurtlesWhat's on the bottom of the tank?How often do you perform water changes for the tank? Please include what percentage is changed each time in your answer.How is the water quality in the tank monitored and how often is this done?Have you had any water quality issues recently? Yes NoHave you added anything to the water? If so, when was this last done?Is the water heated? If so, to what temperature?What type of filter are you using and have you had any issues with this?Do you keep any other types of reptiles, fish or other animals in the same tank? Yes NoLastly, how did you first hear about Exotic Vet Care?(Required) Google (or other search engine) Social media (Facebook, Instagram, YouTube etc) Recommended by a friend or colleague I saw the clinic from the street OtherCAPTCHAΔ
