Online forms

Amphibian History Form

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

Get Started

Amphibian History Form

Thank you for entrusting Cypress Veterinary Clinic for your pet’s care! Please fill out our drop off form in its entirety. We look forward to meeting you!

Name *

First

Last

Email *

Phone

Pet Information

Pet's Name *

Species *

Age *

Sex *

Male
Female
Unknown

Background Information

Where did you acquire pet?

Wild Caught
Captive bred
Unknown

Do you own other amphibians?

If so, kind and how many?

Are they housed together or separately?

Have there been any recent introductions (last 30 days)?

Environment

What is the cage type?

Terrestrial (land dwelling)
Arboreal (Tall, climbing)
Semi-Aquatic
Aquatic

What is the cage size?

What is the cage made of?

Glass
Metal
Plastic/fiberglass
Wood

What substrate is used?

How frequently is the cage cleaned? What cleaning products are used?

What are the temperatures in the cage? Include High, Low and Basking temperatures

What heat sources are used?

What is the humidity?

What light sources are used? How many hours of light are provided a day?

Are there UVA/UVB sources? How frequently are the changed?

Water Quality

What is the water source?

City or local well
Distilled water
Bottled water
Other

If Other, please specify

How often are the filters cleaned or changed?

Is the water heated? Temperature range?

Is any type of water testing done?

If yes, Please provide last results

Date:

pH:

Ammonia:

Nitrite:

Nitrate:

Alkalinity:

Hardness

Dissolved O2:

Nutrition

What is the diet? What is offered? How often?

When did they last eat?

For non-aquatic species, how is water provided?

Miscellaneous

How often is your pet handled?

Daily
Occasionally
Never

Has the animal gone through brumation?

Have there been any recent changes in diet, environment or husbandry?

Ready to visit?

Our mission is to provide high-quality compassionate medicine while maintaining and nurturing the human-animal bond.

Book Appointment call us

have a question?

Get in touch! Complete our form, and a member of our team will be in touch with you shortly.



Address

753 West Cypress Street
Kennett Square, PA 19348



Contact

E: [email protected]
P: 1-484-734-0686



Hours

Mon, Tues, Wed, Fri: 8 am – 6 pm
Thurs: 8 am – 5 pm
Sat & Sun: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

Checkboxes *

By checking this box, you consent to receive calls, emails, and SMS messages from Cypress Veterinary Clinic. For more information, please review our Privacy Policy. Reply STOP to unsubscribe from SMS messages. Messaging and data rates may apply.