Turtle & Tortoise Pre-visit Questionnaire Turtle & Tortoise Questionnaire (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 * Name First First Last Last 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 Email * What is your turtle’s name? * What type of turtle do you have? * What is the birth date or estimated age of your turtle? * Gender? * Male Male/Neutered Female Female/Spayed Unsure Prior vet/clinic information * What are the symptoms of concern for your pet and when did you first notice? * Have you done any home remedies or treatments for your concerns? If so, please list what and how often you've done this. * Has your turtle had any previous medical concerns? * Is your turtle on any current medications? If so please list what medications he is on. * Is your turtle microchipped? * Yes No What do you feed your turtle and how often? * How long have you had your turtle and where did you get it from? * If you are human, leave this field blank. Next
